A non-government entity
American Health Advantage of Pennsylvania (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for American Health Advantage of Pennsylvania (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on American Health Advantage of Pennsylvania (HMO I-SNP) in 2025, please refer to our full plan details page.
American Health Advantage of Pennsylvania (HMO I-SNP) is a HMO I-SNP plan offered by Mitchell Family Office available for enrollment in 2025 to people living in Western Pennsylvania. The overall rating for this plan is not yet available for 2025.
It's important to know that American Health Advantage of Pennsylvania (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:
American Health Advantage of Pennsylvania (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 American Health Advantage of Pennsylvania (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 American Health Advantage of Pennsylvania (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 American Health Advantage of Pennsylvania (HMO I-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The American Health Advantage of Pennsylvania (HMO I-SNP) plan offers a variety of benefits with varying cost-sharing options. Many services have a 20% coinsurance, including outpatient services, emergency services, and ambulance services. Preventive services, primary care physician visits, routine hearing exams, and home health services are covered with no copay. The plan also includes coverage for hearing aids, vision services, and dental services, though some services may have coinsurance or limited coverage.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but the cost sharing details are not provided. Additional days for inpatient hospital, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, as well as Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services with a coinsurance of 20%. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the American Health Advantage of Pennsylvania (HMO I-SNP) plan, 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 a 20% coinsurance for both ground and air ambulance services. Transportation Services to any health-related location are covered with no copay, but transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by American Health Advantage of Pennsylvania (HMO I-SNP) with a 20% coinsurance. Worldwide Emergency Services are not covered.
Primary Care See details
The American Health Advantage of Pennsylvania (HMO I-SNP) plan covers Primary Care Physician Services with no copay, and Chiropractic Services with 20% coinsurance, but Routine Chiropractic Care is not covered. Occupational Therapy Services have a coinsurance between 0% and 20%, and Physician Specialist Services, Mental Health Specialty Services, and Psychiatric Services have coinsurance between 0% and 20%. Podiatry Services have a coinsurance between 0% and 20%, and Medicare-covered podiatry services have no copay. Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services have coinsurance between 0% and 20%, and additional telehealth benefits have no copay. Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services with no copay. Annual physical exams, 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, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, support for caregivers, additional sessions of smoking and tobacco cessation counseling, fitness benefit, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. In-Home Support Services have no copay.
Hearing Services See details
Hearing services with American Health Advantage of Pennsylvania (HMO I-SNP) include coverage for routine hearing exams with no copay and a 20% coinsurance, fitting/evaluation for hearing aids with no copay and no coinsurance, and prescription hearing aids with no copay and a maximum benefit of $500 per ear every year; however, prescription hearing aids for the inner and outer ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The American Health Advantage of Pennsylvania (HMO I-SNP) plan covers vision services, including eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have a 20% coinsurance, while contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades have no copay. There is a combined maximum plan benefit coverage of $300 for all eyewear.
Dental Services See details
Dental Services are partially covered by the American Health Advantage of Pennsylvania (HMO I-SNP) plan. Medicare Dental Services are covered with a 20% coinsurance, while Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by American Health Advantage of Pennsylvania (HMO I-SNP). Medicare Part B Insulin Drugs have a $35 copay, while other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the American Health Advantage of Pennsylvania (HMO I-SNP) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, and Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, lab services, and radiological services, are covered. For diagnostic procedures and radiological services, you may pay up to 20% coinsurance, while lab services have no copay.
Home Health Services See details
Home Health Services are covered by the American Health Advantage of Pennsylvania (HMO I-SNP) with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the American Health Advantage of Pennsylvania (HMO I-SNP) 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 by American Health Advantage of Pennsylvania (HMO I-SNP), with no copay for days 1-100. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services, including acupuncture, over-the-counter items, meal benefits, and several other services, are not covered. No authorization or referrals are required for these services.
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