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Perennial Advantage Premier (HMO-POS I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Perennial Advantage Premier (HMO-POS I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Perennial Advantage Premier (HMO-POS I-SNP) in 2026, please refer to our full plan details page.
Perennial Advantage Premier (HMO-POS I-SNP) is a HMO-POS I-SNP plan offered by Perennial Consortium, LLC available for enrollment in 2025 to people living in Ohio (partial). This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that Perennial Advantage Premier (HMO-POS I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Perennial Advantage Premier (HMO-POS I-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Perennial Advantage Premier (HMO-POS I-SNP).
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 Perennial Advantage Premier (HMO-POS I-SNP), 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 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 Perennial Advantage Premier (HMO-POS I-SNP) plan features a $0 drug deductible, meaning your prescription coverage begins immediately with no deductible to meet. Tier 1 preferred generic drugs are fully covered with no copay for one-month, two-month, and three-month supplies at standard pharmacies and through standard mail order. Tier 2 generic drugs are also very affordable, with standard copays of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. For brand-name and specialty prescriptions, Tier 3 preferred brand drugs require a $45 copay for a one-month supply, while Tier 4 non-preferred drugs require a $95 copay. Tier 5 specialty drugs are subject to a 33% coinsurance for a one-month supply at standard pharmacies and standard mail order. This plan provides clear, structured copayments and coinsurance rates to help you manage your healthcare costs efficiently.
Additional Benefits
The Perennial Advantage Premier (HMO-POS I-SNP) offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a daily copay of $275 for acute care or $280 for psychiatric care for the first five days, followed by no copay for days 6 through 90. Specialist visits and diagnostic procedures are accessible with low copays and no coinsurance, while emergency room visits require a $90 copay. This plan also provides valuable supplemental benefits, including skilled nursing facility stays and select over-the-counter items with no copay and no coinsurance. Dental benefits cover cleanings and exams with no copay or coinsurance up to a $3,100 annual maximum, while routine hearing and vision exams are covered with no copay and a 20% coinsurance. Additionally, members can access up to 12 one-way transportation trips per year to health-related locations with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Perennial Advantage Premier (HMO-POS I-SNP) with no coinsurance, though acute care is only partially covered because facility upgrades are not covered. For acute stays, there is a $275 copay for days 1 through 5 and no copay for days 6 through 90, while psychiatric stays require a $280 copay for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
Perennial Advantage Premier (HMO-POS I-SNP) covers outpatient hospital services with no coinsurance and a $0 to $250 copay, and observation services with a $100 copay and no coinsurance. Ambulatory surgical center, outpatient substance abuse, and outpatient blood services are also covered with no copay and 20% coinsurance.
Partial Hospitalization See details
Perennial Advantage Premier (HMO-POS I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Perennial Advantage Premier (HMO-POS I-SNP), featuring a $250 copay plus coinsurance for ground ambulance services and a 20% coinsurance plus copay for air ambulance services. Transportation benefits are partially covered with no copay and no coinsurance for up to 12 one-way trips per year to any health-related location, though plan-approved health-related locations are not covered.
Emergency Services See details
Perennial Advantage Premier (HMO-POS I-SNP) covers emergency services with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services are covered with a 20% coinsurance (up to $60 per visit) and no copay, while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Perennial Advantage Premier (HMO-POS I-SNP) offers primary care physician and opioid treatment services with no copay and no coinsurance, while specialist, therapy, and podiatry services require copays up to $40 with no coinsurance. Psychiatric and other health professional services feature no copay and 20% coinsurance, and chiropractic services are partially covered (other chiropractic services are not covered) with a $20 copay and 20% coinsurance.
Preventive Services See details
Preventive Services are covered by Perennial Advantage Premier (HMO-POS I-SNP) with no copay and no coinsurance for Medicare-covered services, kidney disease education, and other preventive screenings. The benefit is partially covered, as an annual physical exam and various supplemental services—including health education, in-home safety assessments, medical nutrition therapy, and personal emergency response systems—are not covered.
Hearing Services See details
Hearing services are covered by Perennial Advantage Premier (HMO-POS I-SNP), offering routine exams with no copay and a 20% coinsurance, alongside OTC hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered up to a $2,200 annual limit with no copay or coinsurance, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Perennial Advantage Premier (HMO-POS I-SNP) partially covers vision services with no copay, a 20% coinsurance, and no deductible, including one annual routine eye exam and eyeglasses up to a $300 yearly limit. Contact lenses and other eye exam services are not covered.
Dental Services See details
Perennial Advantage Premier (HMO-POS I-SNP) offers partially covered dental services, where Medicare-covered dental requires no copay and a 20% coinsurance. Other preventive and comprehensive services like cleanings, exams, and implants have no copay and no coinsurance up to a $3,100 annual maximum, though other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Perennial Advantage Premier (HMO-POS I-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance of 0% to 20%, while Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Perennial Advantage Premier (HMO-POS I-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Perennial Advantage Premier (HMO-POS I-SNP) covers medical equipment with no copayments, though prior authorization is required for some items. Durable medical equipment and prosthetic devices carry a 20% coinsurance, while diabetic supplies have no coinsurance and therapeutic shoes or inserts range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Perennial Advantage Premier (HMO-POS I-SNP), requiring prior authorization for all covered services. Covered diagnostic procedures require a $60 copay with no coinsurance, diagnostic radiological services require a $125 copay, and therapeutic radiological services carry a 20% coinsurance, while lab services and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered by Perennial Advantage Premier (HMO-POS I-SNP) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Perennial Advantage Premier (HMO-POS I-SNP) offers cardiac rehabilitation with no copay and requiring prior authorization, meaning some services are covered, though specific sub-services like standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for peripheral artery disease are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Perennial Advantage Premier (HMO-POS I-SNP) covers skilled nursing facility (SNF) services with no copay and no coinsurance, though prior authorization is required and admission is allowed without a prior three-day inpatient hospital stay. This benefit is partially covered, as additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under Perennial Advantage Premier (HMO-POS I-SNP), which offers over-the-counter (OTC) items with no copay and no coinsurance, including nicotine replacement therapy and naloxone. Acupuncture, meal benefits, and other additional services under this category are not covered.
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