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Aspire Health Protect (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aspire Health Protect (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aspire Health Protect (HMO) in 2026, please refer to our full plan details page.
Aspire Health Protect (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 Protect (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 Protect (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 Protect (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $6500.00 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 Protect (HMO) plan offers an enhanced alternative drug benefit with no prescription drug deductible. Under this plan, standard pharmacy costs during the initial coverage phase include a $20 copay for preferred generics, a $47 copay for standard generics, and an $11 copay for specialty drugs. Preferred brands require a 25% coinsurance and non-preferred drugs carry a 33% coinsurance until total drug costs reach $2,100. After reaching $2,100 in yearly out-of-pocket drug costs, you enter the catastrophic coverage phase and pay nothing for covered Part D prescriptions. Individuals who qualify for the low-income subsidy may also receive a premium reduction, lowering their Part D cost-sharing to zero.
Additional Benefits
The Aspire Health Protect (HMO) plan offers essential medical coverage with clear cost-sharing, featuring a $5 copay for primary care visits and a $45 copay for specialists. For urgent care and emergencies, members pay a $25 or $115 copay, respectively, with no coinsurance. Inpatient hospital stays require daily copays for the first few days before transitioning to no copay, while outpatient hospital visits require an $80 copay and 20% coinsurance. Preventive care and the first 20 days of skilled nursing facility stays are covered with no copay and no coinsurance. Routine vision, hearing, and Medicare-covered dental exams are partially covered with a $45 copay, though routine eyewear and hearing aids are excluded. Finally, medical equipment and dialysis services require no copay with a 20% coinsurance, while home infusion insulin is covered with a $35 copay.
Inpatient Hospital See details
Aspire Health Protect (HMO) partially covers inpatient hospital benefits with no coinsurance, requiring a $505 daily copay for days 1-2 and a $300 daily copay for days 3-4 of acute stays, and a $385 daily copay for days 1-5 of psychiatric stays. Prior authorization is required, and there is no copay for subsequent days up to day 90, while additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aspire Health Protect (HMO) covers outpatient services, featuring an $80 copay and 20% coinsurance for outpatient hospital visits, and an $80 copay with no coinsurance for ambulatory surgical center services. Daily hospital observation services require a $385 copay with no coinsurance, while outpatient blood and substance abuse services are covered with a 20% coinsurance and no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Aspire Health Protect (HMO) with a $60 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Aspire Health Protect (HMO) covers ambulance services with a $325 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. Transportation services are partially covered, offering up to 6 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
Aspire Health Protect (HMO) partially covers emergency services, requiring a $115 copay and no coinsurance for emergency care and a $25 copay and no coinsurance for urgently needed services. Worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Primary Care benefits are partially covered by Aspire Health Protect (HMO), as podiatry services are not covered. Patients pay a $5 copay and no coinsurance for primary care, a $45 copay and no coinsurance for specialists, and a 20% coinsurance and no copay for therapy, psychiatric, and mental health services.
Preventive Services See details
Preventive services are partially covered by Aspire Health Protect (HMO), offering Medicare-covered zero-dollar services, health education, memory fitness, kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, and EKGs with no copay or coinsurance. Sub-services that are not covered include annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, chemo wigs, weight management, alternative therapies, therapeutic massage, adult day care, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Aspire Health Protect (HMO) provides partial coverage for hearing services, which includes routine hearing exams for a $45 copay with no coinsurance or deductible. Other services, including hearing aid fitting and evaluations, prescription hearing aids, and over-the-counter (OTC) hearing aids, are not covered.
Vision Services See details
Vision Services are partially covered by Aspire Health Protect (HMO), offering routine eye exams with a $45 copay and no coinsurance. While eyewear is technically covered, only some services are covered in practice, and contact lenses, eyeglasses, lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Aspire Health Protect (HMO), which provides Medicare-covered dental services for a $45 copay and no coinsurance, with prior authorization required. Many sub-services are not covered under this plan, including orthodontics, restorative, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implants, oral surgery, and adjunctive general services.
Home Infusion bundled Services See details
Aspire Health Protect (HMO) covers home infusion bundled services with prior authorization, offering Medicare Part B insulin drugs for a $35 copay and no coinsurance. Other covered Part B chemotherapy, radiation, and infusion drugs require no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under Aspire Health Protect (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aspire Health Protect (HMO) partially covers medical equipment with no copays, though prior authorization is required for most services. Covered durable medical equipment, prosthetic devices, and medical supplies carry a 20% coinsurance, and diabetic supplies range from no coinsurance to 20% coinsurance, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aspire Health Protect (HMO) with prior authorization required. Diagnostic tests and lab services require a $20 copay and no coinsurance, outpatient X-rays require a $20 copay, and diagnostic and therapeutic radiological services require 15% and 20% coinsurance, respectively.
Home Health Services See details
Aspire Health Protect (HMO) covers home health services, though prior authorization is required before you can receive these care benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Aspire Health Protect (HMO) where some services are covered, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. For these non-covered services, members must pay the full cost as there is no plan copay or coinsurance coverage available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Aspire Health Protect (HMO), requiring prior authorization and excluding additional days beyond the Medicare-covered limit. There is no copay and no coinsurance for days 1 through 20, followed by a $214 daily copay and no coinsurance for days 21 through 100.
Other Services See details
Aspire Health Protect (HMO) partially covers Other Services, offering acupuncture benefits for a $20 copay and no coinsurance for up to 4 treatments per year. Over-the-Counter (OTC) items, meal benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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