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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 2025, 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 2025.
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 $125.00. 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 $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 Prime Value MA Only (HMO)
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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 a range of benefits, including coverage for inpatient hospital stays with a $500 copay, outpatient services with varying copays, and emergency services. The plan also covers primary care, hearing, vision, and dental services, with copays and coinsurance depending on the specific service. Additionally, the plan covers home health services with no copay, and skilled nursing facility stays with no copay for the first 20 days. This plan provides additional benefits such as hearing aids up to $1000 per year, eyewear, and up to $2,000 for dental services annually. It also includes coverage for medical equipment and home infusion services. However, it's important to note that certain services like cardiac rehabilitation, and additional hours of home health care are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a $500 copay for a Medicare-covered stay. Additional days are covered with no copay, while upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $200 copay, Observation Services with a $200 copay, Ambulatory Surgical Center (ASC) Services with a $125 copay, Outpatient Substance Abuse Services with a $30 copay for both individual and group sessions, and Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Memorial Hermann Prime Value MA Only (HMO) plan. This benefit has a $50 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, as well as transportation services to plan-approved health-related locations. Ground ambulance services have a $250 copay, while air ambulance services have 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Memorial Hermann Prime Value MA Only (HMO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $25 copay. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $25 copay, and Worldwide Emergency Transportation has a 20% coinsurance. Worldwide Emergency Services have a maximum plan benefit of $50,000.
Primary Care See details
The Memorial Hermann Prime Value MA Only (HMO) plan covers primary care physician services, chiropractic services, occupational therapy, specialist services, psychiatric services, physical therapy, speech-language pathology, and telehealth benefits. Chiropractic services have a $20 copay, specialist services have a $30 copay, occupational therapy has a $30 copay, physical therapy and speech-language pathology services have a $30 copay, and psychiatric services and opioid treatment program services have a $30 copay. Routine chiropractic care and individual and group sessions for mental health specialty services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, and additional preventive services. This plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, telemonitoring services, home and bathroom safety devices and modifications, and counseling services. Services such as wigs for hair loss related to chemotherapy, fitness benefits (memory fitness), enhanced disease management, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered.
Hearing Services See details
Hearing Services include hearing exams with a $20 copay, and the fitting/evaluation for hearing aids benefit is covered. Prescription hearing aids (all types) are covered, with a maximum plan benefit of $1000 every year, but prescription hearing aids for the inner and outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $30 copay. Eyewear is covered with a combined maximum of $1000 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames.
Dental Services See details
Dental Services are covered, with a $2,000 annual maximum. Medicare Dental Services have a $30 copay, while other services include oral exams with a 0-20% coinsurance, and other preventive dental 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 a 50% coinsurance and copays ranging from $4.40 to $1129.70. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Memorial Hermann Prime Value MA Only (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Memorial Hermann Prime Value MA Only (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no coinsurance, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a $25 copay, and diagnostic radiological services with a copay of at most $150, and therapeutic radiological services with a copay of at most $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 Prime Value MA Only (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 not covered by the Memorial Hermann Prime Value MA Only (HMO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Memorial Hermann Prime Value MA Only (HMO) plan. There is no copay for days 1-20, and a $125 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the Memorial Hermann Prime Value MA Only (HMO) plan, 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. Over-the-Counter (OTC) Items are covered up to $75 every three months, and meal benefits are covered for chronic illnesses.
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