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Advantage Care (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Advantage Care (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Advantage Care (HMO) in 2025, please refer to our full plan details page.
Advantage Care (HMO) is a HMO plan offered by Curana Health Holdings, LLC available for enrollment in 2025 to people living in Florida (partial). The overall rating for this plan is not yet available for 2025.
It's important to know that Advantage Care (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 Advantage Care (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 Advantage Care (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 $400.00 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 $3500.00 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 Advantage Care (HMO) plan has a $400 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For preferred and standard pharmacies, you will pay $10 for preferred generic drugs, $45 for standard generic drugs, and $95 for preferred brand drugs. Non-preferred drugs will have a 25% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Advantage Care (HMO) plan provides comprehensive coverage, including inpatient hospital stays with a $200 copay for the first six days. Outpatient services have varying copays and coinsurance, and the plan also covers ambulance services, emergency services, and a range of primary care services with copays and coinsurance. Preventive services are covered with no copay, along with hearing, vision, and dental services with coinsurance. Other key benefits include home health services with no copay, and coverage for medical equipment and diagnostic services with coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered under the Advantage Care (HMO) plan. For Inpatient Hospital-Acute, you'll pay a $200 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you'll pay a $200 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $225, and observation services with a $100 copay. Ambulatory Surgical Center (ASC) Services have a 20% coinsurance. Outpatient Substance Abuse Services have a $30 copay for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by Advantage Care (HMO), but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Advantage Care (HMO) plan. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance; Transportation Services to a plan-approved health-related location are not covered, but transportation services to any health-related location are covered for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services are covered under the Advantage Care (HMO) plan, with a $90 copay for emergency services and a $40 copay for urgently needed services. Worldwide emergency services, urgent coverage, and emergency transportation are not covered.
Primary Care See details
The Advantage Care (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a 20% coinsurance, and routine chiropractic care has a $30 copay for up to 12 visits per year. Physician specialist services have a copay between $0 and $10, while individual mental health sessions have a $20 copay and group sessions have a $10 copay. Routine foot care has a 20% coinsurance, and additional telehealth benefits have a copay between $0 and $20. Individual and group psychiatric sessions have a 20% coinsurance.
Preventive Services See details
The Advantage Care (HMO) plan covers preventive services, including Medicare-covered preventive services, with no copay. Additional preventive services are also covered, but annual physical exams, health education, in-home safety assessments, 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, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams with a coinsurance of at most 20% and routine hearing exams and fitting/evaluation for hearing aids, each covered once per year. Prescription hearing aids are covered, with a maximum benefit of $130 every month, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered; OTC hearing aids are covered.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear, with a 20% coinsurance for eye exams and contact lenses. Eyewear has a combined maximum benefit of $130.00 per month.
Dental Services See details
The Advantage Care (HMO) plan covers dental services, including Medicare dental services with 20% coinsurance, and other dental services with a $1,500 annual maximum. The plan covers oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery, but orthodontics and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Advantage Care (HMO) plan, and require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay, with coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Advantage Care (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Advantage Care (HMO) plan. Diagnostic procedures and tests have a coinsurance of at most 20%, while lab services are not covered. Diagnostic radiological services and therapeutic radiological services have a coinsurance of at most 20%, while outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by the Advantage Care (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 Advantage Care (HMO) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization required, and the plan follows original Medicare cost sharing for tier 1. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under Advantage Care (HMO), acupuncture is covered with a $30 copay for up to 12 treatments per year, while over-the-counter items are covered. Meal benefits, dual eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, case management, institution for mental disease services, services in an intermediate care facility, tobacco cessation counseling, 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.
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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.
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