A non-government entity
Memorial Hermann Advantage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Memorial Hermann Advantage (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Memorial Hermann Advantage (HMO) in 2025, please refer to our full plan details page.
Memorial Hermann Advantage (HMO) is a HMO plan offered by Memorial Hermann Health System available for enrollment in 2025 to people living in TX -Houston area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Memorial Hermann Advantage (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Memorial Hermann Advantage (HMO).
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 Memorial Hermann Advantage (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2950.00 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:
Sign up for Memorial Hermann Advantage (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Memorial Hermann Advantage (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different amounts depending on the drug tier and pharmacy. For example, you may pay a $4 copay for preferred generic drugs at a standard or mail-order pharmacy. The plan offers an enhanced alternative drug benefit.
Additional Benefits
The Memorial Hermann Advantage (HMO) plan offers a wide range of benefits with varying cost-sharing. It covers inpatient hospital stays with a $350 copay, outpatient services with copays ranging from $25 to $200, and includes coverage for ambulance services with a $250 copay for ground transport and 20% coinsurance for air ambulance. The plan also provides coverage for primary care, hearing, vision, and dental services with specific copays and coinsurance. Additional benefits include home health services with no copay, and skilled nursing facility stays with no copay for the first 20 days and a $125 copay per day for days 21-100. The plan also offers a quarterly allowance for over-the-counter items and meal benefits for chronic illness. However, some services like certain hearing aids, orthodontics, and some home and community-based services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a $350 copay for Medicare-covered stays. Additional days and non-Medicare covered stays are also covered, and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a $150 copay, observation services with a $200 copay, ambulatory surgical center services with a $125 copay, and outpatient substance abuse services with a $25 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $50 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Memorial Hermann Advantage (HMO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations are covered for up to 20 one-way trips per year via rideshare, bus/subway, van, medical transport, and other methods, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Memorial Hermann Advantage (HMO). Emergency Services have a $140 copay, and Urgently Needed Services have a $20 copay. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $25 copay, and Worldwide Emergency Transportation has a 20% coinsurance.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, Opioid Treatment Program Services, and Psychiatric Services are covered. Chiropractic services have a $20 copay, Occupational Therapy Services have a $20 copay, Physician Specialist Services have a $15 copay, Physical Therapy and Speech-Language Pathology Services have a $20 copay, and Additional Telehealth Benefits have a $0-$25 copay.
Preventive Services See details
The Memorial Hermann Advantage (HMO) plan covers various preventive services, including annual physical exams, Medicare-covered preventive services, and additional preventive services. The plan also covers wigs for hair loss related to chemotherapy, a fitness benefit (Memory Fitness), enhanced disease management, remote access technologies, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs after a welcome visit. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and many other services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $20 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1,000 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $20 copay, as well as eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. The plan offers a combined maximum benefit of $1000 per year for eyewear.
Dental Services See details
Dental Services are covered, with a $3,000 annual maximum. Medicare dental services have a $20 copay, while other services include oral exams with 0-20% coinsurance, and other preventive services with a $8.80-$52.80 copay and 50% coinsurance. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have 50% coinsurance and copays ranging from $5.50 to $1129.70, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Memorial Hermann Advantage (HMO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay for Diagnostic Procedures/Tests, Diagnostic Radiological Services, and Therapeutic Radiological Services. Diagnostic Procedures/Tests have a copay of $25, while Diagnostic Radiological Services have a copay of $150, and Therapeutic Radiological Services have a copay of $25. Lab Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Memorial Hermann Advantage (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Memorial Hermann Advantage (HMO) plan, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. The copay information for these services is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Memorial Hermann Advantage (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $125 per day. Additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for over-the-counter items, with a maximum benefit of $75 every three months, and meal benefits for chronic illness with no maximum benefit. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved