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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 2025, 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 2025.
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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions. For example, you'll pay a $10 copay for preferred generic drugs at a standard pharmacy or through the mail. For standard generic drugs, the copay is $45, and the copay for preferred brand drugs is $95. Non-preferred drugs have a 25% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Perennial Advantage Premier (HMO-POS I-SNP) plan offers a range of health benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays or coinsurance depending on the service. The plan also covers primary care visits, specialist visits, and mental health services with copays or coinsurance, and offers coverage for hearing, vision, and dental services, with coinsurance and maximum benefit limits. Additional benefits include coverage for ambulance and transportation services, emergency services, and home health services with no copay. The plan also covers home infusion, dialysis, medical equipment, and diagnostic services with coinsurance, as well as OTC items. However, some services like cardiac rehabilitation, additional home health care, and certain vision and dental services are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with a $280 copay for days 1-5 and no copay for days 6-90. Additional days and non-Medicare covered stays are also covered. Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $0-$250, and Observation Services with a $100 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are covered with 20% coinsurance, and Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Perennial Advantage Premier (HMO-POS I-SNP) plan and requires prior authorization. You will pay 20% coinsurance for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Perennial Advantage Premier (HMO-POS I-SNP) plan. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are covered for up to 12 one-way trips per year, and include rideshare services, bus/subway, medical transport, and other transportation options. Transportation services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services have a $90 copay, while Urgently Needed Services have a 20% coinsurance and a maximum per visit amount of $60. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Perennial Advantage Premier (HMO-POS I-SNP) plan covers primary care physician services, chiropractic services with 20% coinsurance, occupational therapy services with a copay between $0 and $25, physician specialist services with a $20 copay, and mental health specialty services with a $35 copay for individual and group sessions. The plan also covers podiatry services, other health care professionals, and psychiatric services with 20% coinsurance. Physical therapy and speech-language pathology services have a copay between $0 and $25, and additional telehealth benefits have a copay between $0 and $35.
Preventive Services See details
The Perennial Advantage Premier (HMO-POS I-SNP) plan covers preventive services, including Medicare-covered services with no copay, but does not cover annual physical exams. The plan also provides additional preventive services, but does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, a fitness benefit, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing services include hearing exams with at most 20% coinsurance and routine hearing exams and fitting/evaluation for hearing aids, each covered once per year. Prescription hearing aids (all types) are covered with a maximum benefit of $2200 per year, and OTC hearing aids are also covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and you are covered for one routine eye exam every year. Eyewear, including eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, have a 20% coinsurance and a combined maximum plan benefit of $300 every year, while contact lenses are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services, and other services have a $3,000 maximum benefit per year. Oral exams are covered for 2 visits per year, dental x-rays are covered for 2 per year, and fluoride treatments are covered every six months. Prophylaxis (cleaning) is covered for 2 visits per year. Implants are covered with no limit. Orthodontic services are partially covered under Diagnostic and Preventive Dental. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%, and also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, both with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Perennial Advantage Premier (HMO-POS I-SNP) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment, including Diabetic Supplies with no coinsurance, and Diabetic Therapeutic Shoes/Inserts with 0-20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Perennial Advantage Premier (HMO-POS I-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Perennial Advantage Premier (HMO-POS I-SNP) 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 not covered by the Perennial Advantage Premier (HMO-POS I-SNP) plan. Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required for this benefit.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, which includes Nicotine Replacement Therapy (NRT) and Naloxone, but does not cover Acupuncture, Meal Benefit, 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. The plan offers OTC benefits with no maximum plan benefit coverage amount.
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