A non-government entity
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 2025, 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 2025.
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 a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7000.00 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:
Sign up for Aspire Health Protect (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aspire Health Protect (HMO) plan has a $200.00 deductible for prescription drugs. After the deductible, you will pay the following costs for drugs in each tier. For tier 1 preferred generic drugs, you will pay $18.00 copay at standard pharmacies. For tier 2 standard generic drugs, you will pay a $47.00 copay at standard pharmacies. Tier 3 preferred brand drugs have a $100.00 copay at standard pharmacies. Non-preferred drugs have a 30% coinsurance at standard pharmacies. Finally, tier 5 specialty drugs have a $11.00 copay at standard pharmacies.
Additional Benefits
The Aspire Health Protect (HMO) plan offers a variety of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have a mix of copays and coinsurance. Emergency and primary care services have copays, and preventive services, including some additional services, are covered. Additional benefits include coverage for ambulance, transportation, and hearing and vision services with copays. The plan also covers dental services and provides coverage for home infusion, dialysis, medical equipment, diagnostic services, home health, and skilled nursing facility stays with specific cost-sharing. However, some services like cardiac rehabilitation and certain other services are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $385 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you pay a $385 copay for days 1-5, and no copay for days 6-90. Additional days, non-Medicare covered stays, and upgrades for Inpatient Hospital-Acute and Additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services with the Aspire Health Protect (HMO) plan include coverage for Outpatient Hospital Services with a copay of $80-$300 and 20% coinsurance, Observation Services with a $385 copay, Ambulatory Surgical Center (ASC) Services with an $80 copay, and both Individual and Group Sessions for Outpatient Substance Abuse with 10% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aspire Health Protect (HMO) plan, with a $60 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $325 copay, while air ambulance services have 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for 6 one-way trips per year. Transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the Aspire Health Protect (HMO) plan with a $110 copay, and no coinsurance. Urgently Needed Services have a $25 copay, and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Under the Aspire Health Protect (HMO) plan, primary care physician services have a $5 copay, and chiropractic services have a $15 copay for routine care. Physician specialist services have a $45 copay, and other health care professional services have a copay between $5 and $45. Individual and group sessions for mental health and psychiatric services have a 10% coinsurance. Physical therapy and speech-language pathology services have a 10% coinsurance, and opioid treatment program services have a 20% coinsurance and a copay of $20.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, but does not cover annual physical exams. Additional preventive services include Health Education, Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams and EKG following Welcome Visit, while the plan does not cover 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 (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services. Kidney Disease Education Services are also covered.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay, while fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids are not covered. Routine hearing exams are offered as an optional supplemental benefit.
Vision Services See details
Vision services include eye exams with a $45 copay, but eyewear is only partially covered as contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered. Routine eye exams are also covered.
Dental Services See details
Dental Services are covered under the Aspire Health Protect (HMO) plan, with a $45 copay for Medicare Dental Services; however, other services like Orthodontic Services, Restorative Services, and Endodontics 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Aspire Health Protect (HMO) plan, but require prior authorization. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Equipment benefits are covered, but limited to specific manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and radiological services. Diagnostic Procedures/Tests and Lab Services have a $20 copay, while Diagnostic Radiological Services have a 10% coinsurance, 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 Protect (HMO) plan with no copay and no 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 not covered by the Aspire Health Protect (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aspire Health Protect (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services for Aspire Health Protect (HMO) covers acupuncture with a $20 copay, but is limited to 4 treatments every year. Over-the-counter items, 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved