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Memorial Hermann Prime Value MA Only (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Memorial Hermann Prime Value MA Only (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Memorial Hermann Prime Value MA Only (HMO) in 2026, please refer to our full plan details page.
Memorial Hermann Prime Value MA Only (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 2026.
It's important to know that Memorial Hermann Prime Value MA Only (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Memorial Hermann Prime Value MA Only (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 Prime Value MA Only (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. Additionally, this plan comes with a Part B Premium reduction of $175.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3950.00 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
Prescription drugs are not covered by Memorial Hermann Prime Value MA Only (HMO).
Additional Benefits
The Memorial Hermann Prime Value MA Only (HMO) plan offers affordable healthcare coverage with no copay and no coinsurance for primary care visits and routine preventive services. Inpatient hospital stays require a $750 copay per stay with no coinsurance, while outpatient hospital services carry a $200 copay. Emergency room visits require a $150 copay, which is waived if you are admitted within 48 hours, and urgent care visits require a $30 copay. This plan also includes key supplemental benefits, featuring routine dental coverage up to a $1,000 annual maximum and eyewear coverage with no copay or coinsurance up to $300 yearly. Routine hearing exams require a $20 copay, and prescription hearing aids are covered with no copay up to a $600 annual limit. Additionally, skilled nursing facility stays feature no copay for the first 20 days, and home health services are provided with no copay and no coinsurance.
Inpatient Hospital See details
Memorial Hermann Prime Value MA Only (HMO) covers inpatient acute and psychiatric hospital stays with a $750 copay per stay, no coinsurance, and unlimited additional days at no copay, subject to prior authorization. This benefit is partially covered because while non-Medicare-covered stays are included, room upgrades for acute care are not covered.
Outpatient Services See details
Memorial Hermann Prime Value MA Only (HMO) covers outpatient services with no coinsurance, featuring a $200 copay for outpatient hospital and observation services and a $125 copay for ambulatory surgical center services. Outpatient substance abuse services require a $30 copay per session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Memorial Hermann Prime Value MA Only (HMO) covers partial hospitalization services with a $50 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services under Memorial Hermann Prime Value MA Only (HMO) are partially covered, as transportation services to health-related locations are not covered. Medicare-covered ground ambulance services require a $250 copay and no coinsurance, while air ambulance services require 20% coinsurance and no copay, with prior authorization required for all ambulance services.
Emergency Services See details
Emergency services are covered by Memorial Hermann Prime Value MA Only (HMO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency and urgent services are covered up to a $50,000 maximum with copays ranging from $30 to $150 and a 20% coinsurance for emergency transportation.
Primary Care See details
Memorial Hermann Prime Value MA Only (HMO) offers primary care physician services with no copay and no coinsurance, while specialist, physical therapy, occupational therapy, and opioid treatment services require a $40 copay and no coinsurance. Telehealth and psychiatric services are covered with copays ranging up to $40 and no coinsurance, but chiropractic, mental health specialty, and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Memorial Hermann Prime Value MA Only (HMO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. Additional preventive benefits are partially covered, featuring fitness programs and remote access technologies, but do not cover health education, weight management, nutritional/dietary benefits, or in-home safety assessments.
Hearing Services See details
Memorial Hermann Prime Value MA Only (HMO) covers hearing services, including routine hearing exams and evaluations with a $20 copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $600 annual maximum, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Memorial Hermann Prime Value MA Only (HMO) provides partially covered vision services, including routine eye exams for a $30 copay and no coinsurance, though other eye exams are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a $300 combined maximum limit every year.
Dental Services See details
Memorial Hermann Prime Value MA Only (HMO) partially covers dental services up to a $1,000 annual maximum, though maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare-covered dental has a $30 copay and no coinsurance, while other covered preventive and comprehensive services range from no copay to copays up to $1,129.70, and no coinsurance to 50% coinsurance.
Home Infusion bundled Services See details
Memorial Hermann Prime Value MA Only (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Memorial Hermann Prime Value MA Only (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Memorial Hermann Prime Value MA Only (HMO) with no copays, though a 20% coinsurance applies to durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Covered diabetic supplies also feature no copay, with coinsurance ranging from no coinsurance up to 20%.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Memorial Hermann Prime Value MA Only (HMO) with no coinsurance, excluding lab services and outpatient X-ray services which are not covered. Covered diagnostic procedures and tests have a $25 copay, while diagnostic radiological services require a $150 copay and therapeutic radiological services have a $25 copay.
Home Health Services See details
Home health services are covered under the Memorial Hermann Prime Value MA Only (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no coinsurance under the Memorial Hermann Prime Value MA Only (HMO) plan, where some services are covered. However, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, and Pulmonary Rehabilitation services are not covered and require a $40 copay, while Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) is also not covered and requires a $30 copay.
Skilled Nursing Facility (SNF) See details
Memorial Hermann Prime Value MA Only (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $125 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Memorial Hermann Prime Value MA Only (HMO) partially covers Other Services, providing a chronic illness meal benefit with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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