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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 2025, 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 2025.
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 $27.00. 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 has an enhanced alternative drug benefit with a $0 deductible. During the initial coverage phase, you will pay different copays depending on the drug tier and pharmacy used. For example, a standard pharmacy has a $18 copay for preferred generic drugs, and a $47 copay for standard generic drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Aspire Health Value (HMO) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, outpatient services with varying copays and coinsurance, and partial hospitalization with a $45 copay. It also covers ambulance services, emergency care, and primary care visits with copays. Additional benefits include coverage for preventive services, hearing exams with a $45 copay, eye exams with a $45 copay, and some dental services with a $45 copay. The plan also covers home infusion, dialysis, medical equipment, diagnostic services, home health services, cardiac rehabilitation, skilled nursing facility stays, and acupuncture. Some services have copays or coinsurance, while others require prior authorization.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $375 for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $80 and $300 and 20% coinsurance, observation services with a $375 copay, ambulatory surgical center services with an $80 copay, and outpatient substance abuse services with a $35 copay for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aspire Health Value (HMO) plan, requiring prior authorization. The copay for this benefit is $45.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aspire Health Value (HMO) plan. Ground ambulance services have a $325 copay, and air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for 6 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 under the Aspire Health Value (HMO) plan. Emergency Services have a $110 copay with no coinsurance, and Urgently Needed Services have a $25 copay with no coinsurance, but Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are not covered.
Primary Care See details
The Aspire Health Value (HMO) plan covers primary care physician services with a $5 copay, chiropractic services with a $10 copay, and occupational therapy services with a $25 copay. It also covers physician specialist services with a $45 copay, mental health and psychiatric services with a $35 copay for individual and group sessions, physical therapy and speech-language pathology services with a $25 copay, and opioid treatment program services with a copay between $20 and $35. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, with some services not covered. The plan covers Health Education, and Fitness Benefit, but does not cover Annual Physical Exams, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, or Counseling Services. The plan also covers 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 $45 copay, while Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams with a $45 copay, and eyewear, though contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered. Routine eye exams are available as an optional, supplemental benefit.
Dental Services See details
Dental Services are partially covered under the Aspire Health Value (HMO) plan, with a $45 copay for Medicare Dental Services, but Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aspire Health Value (HMO) plan, but require prior authorization. The coinsurance for Dialysis Services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices and Medical Supplies with a 20% coinsurance. Some services are covered, but 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 covered, with copays and coinsurance depending on the specific service. Diagnostic Procedures/Tests and Lab Services have a $20 copay, while Diagnostic Radiological Services have a copay between $90 and $250. Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Aspire Health Value (HMO) plan with no copay or 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 covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, or Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services. Prior authorization is required, and the copay information can be found in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Aspire Health Value (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $184.
Other Services See details
The Aspire Health Value (HMO) plan covers acupuncture with a $20 copay, up to 4 treatments per year. Other services like over-the-counter items, meal benefits, and several other services are not covered.
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