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WV Senior Advantage (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for WV Senior Advantage (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on WV Senior Advantage (HMO I-SNP) in 2026, please refer to our full plan details page.
WV Senior Advantage (HMO I-SNP) is a HMO I-SNP plan offered by SNP Holdings, LLC available for enrollment in 2025 to people living in West Virginia (partial). This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that WV Senior Advantage (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
WV Senior Advantage (HMO 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 WV Senior Advantage (HMO 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 WV Senior Advantage (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.70. 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 $615.00 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 $9250.00 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 WV Senior Advantage (HMO I-SNP) prescription drug coverage includes an annual drug deductible of $615. You will need to pay this deductible amount out of pocket for your medications before the plan begins to cover its share of your prescription costs. Specific drug tier details, such as copayments and coinsurance for individual formulary tiers, are not available for this plan. To determine your exact out-of-pocket costs, you should review the plan's complete drug formulary or contact the plan administrator directly.
Additional Benefits
The WV Senior Advantage (HMO I-SNP) plan offers comprehensive coverage with no copay for many essential services, though a 20% coinsurance typically applies to outpatient care, primary and specialist visits, diagnostics, and durable medical equipment. Inpatient hospital stays, home health services, and skilled nursing facility care are also covered with no copay, although prior authorization is required for most of these benefits. Emergency room visits carry a $100 copay, which is waived if you are admitted to the hospital within three days. Additionally, the plan features robust supplemental benefits that require no copay or coinsurance, including up to $2,500 for dental care, a $2,000 allowance for hearing services, and a $300 annual allowance for eyewear. Members also benefit from up to 36 free one-way transportation trips per year to plan-approved locations and covered home health visits at no cost. Preventive care services are also fully covered with no copay or coinsurance.
Inpatient Hospital See details
WV Senior Advantage (HMO I-SNP) covers inpatient acute and psychiatric hospital stays with no copay, though prior authorization is required and Medicare-defined cost-sharing applies. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered by WV Senior Advantage (HMO I-SNP) with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
WV Senior Advantage (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
WV Senior Advantage (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by WV Senior Advantage (HMO I-SNP) with a $100 copay and no coinsurance, with the copay waived if you are admitted to the hospital within three days. Urgently needed services are covered with 20% coinsurance (up to $40 per visit) and no copay, but worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Primary care benefits under the WV Senior Advantage (HMO I-SNP) plan, including specialist visits, mental health, and physical therapy, are covered with no copay and a 20% coinsurance, while telehealth services have no copay and no coinsurance. Chiropractic services are not covered, but routine foot care is covered with no copay and a 20% coinsurance for up to 18 visits per year.
Preventive Services See details
Preventive services are covered by WV Senior Advantage (HMO I-SNP) with no copay and no coinsurance for Medicare-covered zero-dollar services and screenings like glaucoma and diabetes self-management. Kidney disease education is covered with no copay and a 20% coinsurance, while annual physical exams and additional preventive benefits are not covered.
Hearing Services See details
WV Senior Advantage (HMO I-SNP) offers partial coverage for hearing services with no copay and no coinsurance, subject to a $2,000 annual maximum. Unlimited routine hearing exams and fitting evaluations are covered, but OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
WV Senior Advantage (HMO I-SNP) partially covers vision services with no copay, no coinsurance, and no deductible, though other eye exam services are not covered. Covered benefits include one routine eye exam per year and a $300 annual maximum allowance for eyewear, including contacts, eyeglasses, and upgrades.
Dental Services See details
WV Senior Advantage (HMO I-SNP) provides partially covered dental services with no copay and no coinsurance up to a maximum annual benefit of $2,500. Covered dental care includes exams, cleanings, and various restorative and surgical services, while fluoride treatment, adjunctive general services, and orthodontics are not covered.
Home Infusion bundled Services See details
WV Senior Advantage (HMO I-SNP) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the WV Senior Advantage (HMO I-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
WV Senior Advantage (HMO I-SNP) covers durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for DME and prosthetics, but there are no manufacturer limitations for diabetic supplies or preferred vendors for DME.
Diagnostic and Radiological Services See details
WV Senior Advantage (HMO I-SNP) partially covers diagnostic and radiological services, though lab services are not covered. Covered services, including diagnostic procedures, diagnostic and therapeutic radiological services, and outpatient X-rays, require prior authorization and have no copay but carry a 20% coinsurance.
Home Health Services See details
WV Senior Advantage (HMO I-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the WV Senior Advantage (HMO I-SNP) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation sub-services are all not covered. These services require a 20% coinsurance and no copay, and prior authorization is required.
Skilled Nursing Facility (SNF) See details
WV Senior Advantage (HMO I-SNP) provides partially covered Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. Under this plan, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the WV Senior Advantage (HMO I-SNP) plan, meaning there is no coverage, copay, or coinsurance for acupuncture, over-the-counter (OTC) items, and meal benefits.
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