A non-government entity
Aspire Health Advantage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aspire Health Advantage (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aspire Health Advantage (HMO) in 2025, please refer to our full plan details page.
Aspire Health Advantage (HMO) is a HMO plan offered by Montage Health available for enrollment in 2025 to people living in Monterey County. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Aspire Health 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 Aspire Health 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 Aspire Health Advantage (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $146.00. 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 $4300.00 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 Aspire Health 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 Aspire Health Advantage (HMO) plan has an "Enhanced Alternative" drug benefit. The plan has no deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions. For example, you will pay $8 for preferred generic drugs at a standard pharmacy, and $45 for standard generic drugs at a standard pharmacy. Once your total drug costs reach $2,000, you will enter the next coverage phase. In the catastrophic coverage phase, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aspire Health Advantage (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services include copays and coinsurance depending on the service. Primary care, specialist visits, mental health, and therapy services have copays, while preventive services and home health services are covered. This plan also covers ambulance services with copays or coinsurance, and emergency services with a copay. Dental, vision, and hearing services are offered, but with limitations on what is covered. Additionally, the plan includes coverage for home infusion and dialysis with copays or coinsurance, along with medical equipment and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered. For days 1-6, there is a $275 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $60-$275 copay and 20% coinsurance, Observation Services with a $275 copay, Ambulatory Surgical Center Services with a $60 copay, and Outpatient Substance Abuse Services with a $15 copay for both individual and group sessions. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $30 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $325 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 12 one-way trips per year using rideshares, buses, subways, or other transportation, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Aspire Health Advantage (HMO) plan with a $110 copay and no coinsurance. Urgently Needed Services are covered with no copay and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic services have a $10 copay, and routine chiropractic care has a $10 copay for up to 6 visits per year. Occupational Therapy Services have a $15 copay. Physician Specialist Services have a $25 copay, and Physical Therapy and Speech-Language Pathology Services have a $15 copay. Mental Health and Psychiatric Services have a $15 copay for individual and group sessions, and Opioid Treatment Program Services have a copay between $10 and $15. Other Health Care Professional services have a copay between $0 and $25. Podiatry Services are not covered.
Preventive Services See details
The Aspire Health Advantage (HMO) plan covers preventive services, including Medicare-covered preventive services and additional preventive services like Health Education and Fitness Benefit, while services such as Annual Physical Exams, In-Home Safety Assessments, and others are not covered. Other covered services include Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit.
Hearing Services See details
Hearing Services include routine hearing exams with a $25 copay; however, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $25 copay, and eyewear, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered. This plan requires prior authorization for eyewear.
Dental Services See details
Aspire Health Advantage (HMO) covers Medicare Dental Services with a $25 copay and other dental services including oral exams, dental x-rays, and prophylaxis (cleaning). However, fluoride treatments, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, fixed prosthodontics, 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 a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Aspire Health Advantage (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits include coverage for 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 Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered by the Aspire Health Advantage (HMO) plan. Diagnostic Procedures/Tests and Lab Services have a $10 copay, while Diagnostic Radiological Services have a copay between $60 and $150, and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aspire Health Advantage (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aspire Health Advantage (HMO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aspire Health Advantage (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $100 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture with a $10 copay for up to 6 treatments per year, and over-the-counter items with a maximum coverage amount of $30 every three months. Meal Benefit, 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