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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 2025, 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 4 out of 5 stars in 2025.
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 $48.40. 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 $590.00 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 $9350.00 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) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you will enter the next coverage phase. If you qualify for the low-income subsidy (LIS), you may have a reduced premium. During the catastrophic coverage phase, after your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The WV Senior Advantage (HMO I-SNP) plan offers a wide range of benefits with varying cost-sharing. You'll find no copay for ambulance, transportation, and home health services, as well as diagnostic and radiological services, and Medicare-covered preventive services. However, you will typically pay a 20% coinsurance for many services, including outpatient, primary care, and medical equipment. This plan covers essential services like inpatient and outpatient care, primary care, hearing, vision, and dental, with a $2,000 maximum benefit for hearing and dental. Emergency services have a $100 copay, and this plan does not require authorization or referrals for services.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered by the WV Senior Advantage (HMO I-SNP) plan, though the specific coinsurance is not detailed. Additional days for inpatient hospital, non-Medicare covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, all with a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for up to 36 one-way trips per year.
Emergency Services See details
Emergency Services are covered by the WV Senior Advantage (HMO I-SNP) plan with a $100 copay and no coinsurance. Urgently Needed Services are covered with 20% coinsurance and no copay. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are not covered.
Primary Care See details
The WV Senior Advantage (HMO I-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, and opioid treatment program services have a 20% coinsurance, while occupational therapy services, physical therapy and speech-language pathology services have no coinsurance.
Preventive Services See details
The WV Senior Advantage (HMO I-SNP) plan covers Medicare-covered preventive services with no copay. Kidney Disease Education Services have a coinsurance of 20%. Other preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered. However, Annual Physical Exams, Health Education, 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, Fitness Benefit, 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 are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, with no deductible. Prescription hearing aids (all types) are covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered. The maximum plan benefit for hearing exams is $2,000 every year.
Vision Services See details
Vision services are covered, including routine eye exams with one visit per year, and eyewear. Eyewear has a combined maximum benefit of $300 per year, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The WV Senior Advantage (HMO I-SNP) plan covers a range of dental services, including oral exams, dental x-rays, prophylaxis (cleaning), restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery. This plan has a maximum benefit of $2,000 per year, but does not cover fluoride treatment, adjunctive general services, maxillofacial prosthetics, implant services, prosthodontics (fixed), or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the WV Senior Advantage (HMO I-SNP) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Supplies have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for any services. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by WV Senior Advantage (HMO I-SNP) 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 WV Senior Advantage (HMO I-SNP) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare stays are not covered. Prior authorization is required.
Other Services See details
Other Services are not covered by the WV Senior Advantage (HMO I-SNP) plan, including acupuncture, over-the-counter items, meal benefits, and more. The plan does not require authorization or referrals for services.
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