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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 2025, 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 2025.
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 $336.00. 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) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions, depending on the drug tier and pharmacy. For example, standard generic drugs have a $42 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aspire Health Plus (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a copay, and ambulance services with a copay or coinsurance. You'll also find coverage for primary care, preventive services, and home health services, often with no copay. This plan provides additional coverage for services like vision and dental, with copays for exams, but with limited coverage for eyewear and dental procedures. Other covered services include home infusion, dialysis, and medical equipment, with varying copays and coinsurance, as well as coverage for hearing and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the Aspire Health Plus (HMO-POS) plan. For days 1-5, there is a $250 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $40-$200 copay and 20% coinsurance, Observation Services with a $250 copay, and Ambulatory Surgical Center (ASC) Services with a $40 copay. Outpatient Substance Abuse Services (Individual Sessions and Group Sessions) and Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information on the copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aspire Health Plus (HMO-POS) plan. 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 rideshare services, bus/subway, or other transportation methods. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the Aspire Health Plus (HMO-POS) plan with a $110 copay and no coinsurance; however, Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered. If admitted to the hospital within 24 hours of the emergency, the copay is waived.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services (up to 12 visits per year), Occupational Therapy Services, Physician Specialist Services with a $20 copay, Other Health Care Professional services with a $0-$20 copay, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Mental Health Specialty Services and Psychiatric Services are partially covered, with individual and group sessions not covered, and Podiatry Services are not covered.
Preventive Services See details
The Aspire Health Plus (HMO-POS) plan covers preventive services, including Medicare-covered services with no copay, and additional services like health education and fitness benefit. Annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services with Aspire Health Plus (HMO-POS) includes routine hearing exams with a $20 copay, but fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids are not covered. This is an optional supplemental benefit, so you may have to pay more for access to this benefit.
Vision Services See details
Vision services include eye exams with a $20 copay, and eyewear, though contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered. This is an optional supplemental benefit, so you may have to pay more for access.
Dental Services See details
Dental Services are partially covered by the Aspire Health Plus (HMO-POS) plan, with Medicare Dental Services covered for a $20 copay. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, 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. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aspire Health Plus (HMO-POS) plan, but require prior authorization. The coinsurance for Dialysis Services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance and no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by Aspire Health Plus (HMO-POS). Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered, while Diagnostic Radiological Services have a copay of at most $100 (minimum $30), and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Aspire Health Plus (HMO-POS) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not covered in practice; Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aspire Health Plus (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $100.
Other Services See details
The Aspire Health Plus (HMO-POS) plan covers acupuncture with a limit of 12 treatments per year, and over-the-counter (OTC) items up to $30 every three months. Meal benefits, 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.
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