A non-government entity
Aspire Health Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aspire Health Value (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aspire Health Value (HMO) in 2026, please refer to our full plan details page.
Aspire Health Value (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 2026.
It's important to know that Aspire Health Value (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 Value (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 Value (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $60.00. 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 $6000.00 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
The Aspire Health Value (HMO) plan offers an Enhanced Alternative drug benefit with no prescription drug deductible, allowing your coverage to begin immediately. Under this plan, standard pharmacy copays during the initial coverage phase are $20 for preferred generics, $47 for standard generics, and $11 for specialty tier drugs. For other tiers, you will pay a 25% coinsurance for preferred brands and a 33% coinsurance for non-preferred drugs. These cost-sharing rates apply until your total drug costs reach $2,100, after which you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Furthermore, if you qualify for the low-income subsidy, your Part D premium may be reduced to $22.60. This plan provides a structured and predictable way to manage your healthcare and prescription medication costs.
Additional Benefits
The Aspire Health Value (HMO) plan offers comprehensive coverage for core medical needs, including doctor visits with a low $5 copay for primary care and a $45 copay for specialists. Emergency room visits require a $115 copay, while inpatient hospital stays are covered with daily copays for the first few days and no copay for longer stays. Outpatient hospital services generally range from an $80 to $300 copay with a 20% coinsurance. For routine care, the plan provides routine hearing, vision, and Medicare dental exams for a $45 copay, though it does not cover hardware like eyeglasses, hearing aids, or comprehensive dental procedures. Additionally, members can access up to six one-way approved transportation trips with no copay, and skilled nursing facility stays feature no copay for the first 20 days. Medical equipment and dialysis services are also covered, typically requiring a 20% coinsurance and no copay.
Inpatient Hospital See details
Aspire Health Value (HMO) partially covers inpatient hospital stays with no coinsurance, but does not cover additional days, upgrades, or non-Medicare-covered stays. Covered acute stays require a daily copay of $500 for days 1-2, $300 for days 3-4, and no copay for days 5-90, while psychiatric stays require a daily copay of $375 for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Aspire Health Value (HMO) covers outpatient hospital services with an $80 to $300 copay and 20% coinsurance, and ambulatory surgical center services with an $80 copay and no coinsurance. Outpatient substance abuse services require a $35 copay with no coinsurance, outpatient blood services carry a 20% coinsurance with no copay, and observation services require a $375 daily copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Aspire Health Value (HMO) with a $45 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Aspire Health Value (HMO) partially covers ambulance and transportation services, as transportation to any health-related location is not covered. Ground ambulance services require a $325 copay with no coinsurance, air ambulance requires 20% coinsurance with no copay, and covered transportation offers up to 6 one-way plan-approved trips with no copay or coinsurance.
Emergency Services See details
Aspire Health Value (HMO) partially covers emergency services with a $115 copay and no coinsurance for emergency room visits, and a $25 copay and no coinsurance for urgently needed services. Worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered under this plan.
Primary Care See details
Primary Care benefits are partially covered by Aspire Health Value (HMO), as podiatry services are not covered. Covered services require no coinsurance, with copays of $5 for primary care visits, $45 for specialists, and between $10 and $35 for chiropractic, therapy, and mental health services.
Preventive Services See details
Preventive services are partially covered under Aspire Health Value (HMO) with no copay or coinsurance for Medicare-covered zero-dollar services, health education, and kidney disease education. However, several sub-services are not covered, including annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing services are partially covered by Aspire Health Value (HMO), which offers routine hearing exams for a $45 copay with no coinsurance or deductible. Fitting and evaluation for hearing aids and OTC hearing aids are not covered, and while some prescription hearing aid services are covered, in practice all types (inner ear, outer ear, and over the ear) are not covered.
Vision Services See details
Vision Services are partially covered by Aspire Health Value (HMO), which offers routine eye exams for a $45 copay, no coinsurance, and no deductible. For eyewear, some services are covered but contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are partially covered by Aspire Health Value (HMO), with covered Medicare Dental Services requiring a $45 copay and no coinsurance. Sub-services not covered under this plan include restorative, orthodontic, endodontic, periodontic, prosthodontic, implant, oral and maxillofacial surgery, maxillofacial prosthetic, and adjunctive general services.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Aspire Health Value (HMO) plan, requiring prior authorization and step therapy. Covered Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Aspire Health Value (HMO) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required for these services.
Medical Equipment See details
Medical Equipment is partially covered by Aspire Health Value (HMO) as diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment, prosthetics, and medical supplies require no copay and a 20% coinsurance, while covered diabetic supplies require no copay and coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
Aspire Health Value (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests, lab services, and outpatient X-rays require a $20 copay and no coinsurance, while diagnostic radiological services carry a $90 to $250 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance with no copay.
Home Health Services See details
Home health services are covered under the Aspire Health Value (HMO) plan, with prior authorization required before services can be received.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aspire Health Value (HMO) plan, which offers no coverage or cost-sharing benefits for cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, or supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Aspire Health Value (HMO), as additional days beyond the Medicare-covered limit are not covered. Covered stays require prior authorization and have no coinsurance, offering no copay for days 1 to 20 and a $184 daily copay for days 21 to 100.
Other Services See details
Aspire Health Value (HMO) partially covers Other Services, providing acupuncture benefits for up to 4 treatments per year with a $20 copay and no coinsurance. Over-the-counter items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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