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American Health Advantage of Texas (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for American Health Advantage of Texas (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on American Health Advantage of Texas (HMO I-SNP) in 2025, please refer to our full plan details page.
American Health Advantage of Texas (HMO I-SNP) is a HMO I-SNP plan offered by Mitchell Family Office available for enrollment in 2025 to people living in Northeast Texas and Lubbock County. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that American Health Advantage of Texas (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
American Health Advantage of Texas (HMO I-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about American Health Advantage of Texas (HMO I-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For American Health Advantage of Texas (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.30. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The American Health Advantage of Texas (HMO I-SNP) plan has a defined standard drug benefit. The plan has a deductible of $590.00. If you qualify for the low-income subsidy, the monthly premium is $18.30. After you meet your deductible, you will pay the cost for your drugs until your total drug costs reach $2000. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for your Part D covered drugs.
Additional Benefits
The American Health Advantage of Texas (HMO I-SNP) plan offers a range of benefits with varying cost-sharing. Many services have no copay, including Primary Care Physician services, Home Health, and Skilled Nursing Facility (SNF) days 1-100. However, services such as outpatient hospital services, emergency services, and vision exams have a 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but the cost sharing details are not explicitly stated. Additional days, non-Medicare stays, and upgrades for inpatient hospital acute and inpatient psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services and observation services, both with a 20% coinsurance, and outpatient substance abuse services including individual and group sessions, both with a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the American Health Advantage of Texas (HMO I-SNP) plan. This benefit has a 20% coinsurance, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by American Health Advantage of Texas (HMO I-SNP), with a 20% coinsurance for both ground and air ambulance services. Transportation Services have no copay. Transportation Services - Any Health-related Location covers 36 one-way trips every year.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under this plan with a 20% coinsurance and no copay. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are not covered.
Primary Care See details
Primary Care benefits cover Primary Care Physician Services with no copay, Chiropractic Services with 20% coinsurance, Occupational Therapy Services with 0-20% coinsurance, Physician Specialist Services with 0-20% coinsurance, and Mental Health Specialty Services with 0-20% coinsurance for individual and group sessions. Also covered are Podiatry Services with 0-20% coinsurance, and routine foot care, Other Health Care Professional services with 0-20% coinsurance, Psychiatric Services with 0-20% coinsurance for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with 0-20% coinsurance, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with no copay. However, routine chiropractic care is not covered.
Preventive Services See details
Preventive Services are covered, with no copay for Medicare-covered services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, and a doctor referral is required for additional preventive services. The plan does not cover annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services. In-Home Support Services have no copay.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Routine hearing exams have no copay and at most 20% coinsurance, while fitting/evaluation for hearing aids have no copay and no coinsurance. Prescription hearing aids are covered with a maximum benefit of $500 per year, and have no copay.
Vision Services See details
The American Health Advantage of Texas (HMO I-SNP) plan covers vision services, including eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no copay. Eyewear has a 20% coinsurance, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
Dental services are partially covered under this plan, with a 20% coinsurance for Medicare Dental Services. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the American Health Advantage of Texas (HMO I-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies and Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services have no copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the American Health Advantage of Texas (HMO I-SNP) plan. There is no copay for days 1-100.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter items, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more. No authorization or referral is required for these services.
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