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Aspire Health Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aspire Health Plus (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aspire Health Plus (HMO-POS) in 2026, please refer to our full plan details page.
Aspire Health Plus (HMO-POS) is a HMO-POS 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 2026.
It's important to know that Aspire Health Plus (HMO-POS) 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 Plus (HMO-POS).
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 Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $366.00. 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 combined Maximum Out-Of-Pocket cost of $3900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $3900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Aspire Health Plus (HMO-POS) Medicare plan features an Enhanced Alternative drug benefit with no prescription drug deductible, meaning your coverage starts right away. During the initial coverage phase at standard pharmacies, you will pay a $10 copay for preferred generics, a $45 copay for standard generics, and an $11 copay for specialty tier drugs. Preferred brand drugs require a 25% coinsurance, while non-preferred drugs carry a 33% coinsurance. The standard Part D premium is $119.20, which is reduced to $107.20 for individuals who qualify for full Low-Income Subsidy extra help. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for your covered Medicare Part D prescription drugs.
Additional Benefits
The Aspire Health Plus (HMO-POS) plan offers affordable essential medical coverage with no copay for primary care visits, telehealth, and urgently needed care. Specialist visits, routine vision and hearing exams, and Medicare-covered dental services are accessible with a low $20 copay and no coinsurance. For emergency room visits, members pay a $115 copay, which is waived upon hospital admission, while inpatient hospital stays require daily copays that drop to no copay after the fourth day. For specialized needs, ground ambulance services require a $325 copay, and the plan provides up to 12 one-way transportation trips to approved locations with no copay. Skilled nursing facility stays are highly affordable, featuring no copay for the first 20 days and a $100 daily copay for days 21 through 100. Additionally, Medicare Part B insulin is capped at a $35 copay, while dialysis and durable medical equipment carry a 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Aspire Health Plus (HMO-POS) with no coinsurance, though additional days, non-Medicare-covered stays, and upgrades are not covered. Acute hospital stays require a daily copay of $550 for days 1-2, $250 for days 3-4, and no copay for days 5-90, while psychiatric stays require a daily copay of $250 for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Aspire Health Plus (HMO-POS) covers outpatient hospital services with a $40 to $200 copay and 20% coinsurance, ambulatory surgical center services with a $40 copay and no coinsurance, and daily observation services with a $250 copay and coinsurance. Outpatient blood services are covered with no deductible, copay, or coinsurance, while outpatient substance abuse services are not covered.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Aspire Health Plus (HMO-POS), though prior authorization is required to receive these services. Specific copay and coinsurance cost information is not specified for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aspire Health Plus (HMO-POS), featuring ground ambulance services with a $325 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation is partially covered, offering up to 12 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are partially covered by Aspire Health Plus (HMO-POS), requiring a $115 copay and no coinsurance for emergency visits, which is waived if admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and no coinsurance, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Aspire Health Plus (HMO-POS) covers primary care, telehealth, therapies, and routine chiropractic care with no copay and no coinsurance. Specialist visits require a $20 copay with no coinsurance, other health professionals range from no copay to a $20 copay with no coinsurance, while podiatry, psychiatric, and mental health specialty services are not covered.
Preventive Services See details
Preventive services are partially covered by Aspire Health Plus (HMO-POS), featuring no copays or coinsurance for Medicare-covered zero-dollar services, health education, and glaucoma screenings. However, several benefits are not covered, including annual physical exams, in-home safety assessments, personal emergency response systems, and medical nutrition therapy.
Hearing Services See details
Aspire Health Plus (HMO-POS) partially covers hearing exams, offering routine hearing exams for a $20 copay and no coinsurance, though fitting and evaluations are not covered. For prescription hearing aids, some services are covered, but inner ear, outer ear, over the ear, and all other prescription and over-the-counter hearing aids are not covered in practice.
Vision Services See details
Aspire Health Plus (HMO-POS) covers routine eye exams as an optional supplemental benefit with a $20 copay, no deductible, and no coinsurance. Eyewear is not covered under this plan, as contact lenses, eyeglasses, lenses, frames, and upgrades are all excluded from coverage.
Dental Services See details
Aspire Health Plus (HMO-POS) partially covers dental services, offering Medicare-covered dental care with a $20 copay and no coinsurance, subject to prior authorization. However, other dental sub-services, including restorative care, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aspire Health Plus (HMO-POS) and require prior authorization. Medicare Part B insulin drugs feature a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under Aspire Health Plus (HMO-POS) with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aspire Health Plus (HMO-POS) partially covers medical equipment, as diabetic therapeutic shoes and inserts are not covered. Covered services require no copay and carry a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by Aspire Health Plus (HMO-POS), with prior authorization required for covered services, while diagnostic procedures, lab services, and outpatient X-ray services are not covered. Covered diagnostic radiological services require a $30 to $100 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance with no copay.
Home Health Services See details
Aspire Health Plus (HMO-POS) covers home health services, though prior authorization is required to access these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the Aspire Health Plus (HMO-POS) plan indicate some services are covered, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. Since these services are not covered in practice, there are no copays or coinsurance options available for members.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Aspire Health Plus (HMO-POS) with prior authorization, featuring no copay and no coinsurance for days 1 to 20, and a $100 daily copay with no coinsurance for days 21 to 100. This benefit is partially covered, as additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Aspire Health Plus (HMO-POS), offering up to 12 acupuncture treatments per year with no specified copay or coinsurance details. Over-the-counter (OTC) items, meal benefits, and dual eligible SNPs with highly integrated services are not covered under this plan.
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