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 2026, 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 2026.
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 $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:
Sign up for American Health Advantage of Pennsylvania (HMO I-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The American Health Advantage of Pennsylvania (HMO I-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan begins to cover its share of your prescription costs. Specific drug coverage tier details, including individual copayments and coinsurance rates for different medication tiers, are not currently available for this plan. To determine your exact prescription costs, you should consult the plan's formulary or contact the provider directly to see how your specific medications are covered.
Additional Benefits
The American Health Advantage of Pennsylvania (HMO I-SNP) plan offers comprehensive medical coverage with many services featuring no copay. Beneficiaries pay no copay and no coinsurance for primary care visits, home health services, and skilled nursing facility care up to 100 days. For outpatient hospital services, emergency care, and specialist visits, members generally face no copay but are responsible for a twenty percent coinsurance. Specialty benefits are partially covered, including routine vision exams and prescription hearing aids up to five hundred dollars per ear with no copay. Medicare-covered dental services and durable medical equipment require a twenty percent coinsurance and no copay, while routine dental care and over-the-counter items are not covered. Additionally, most Part B drugs and home infusion services carry no copay, though Medicare Part B insulin requires a thirty-five dollar copay.
Inpatient Hospital See details
American Health Advantage of Pennsylvania (HMO I-SNP) covers inpatient acute and psychiatric hospital services with no coinsurance, although Medicare-defined cost-sharing applies and prior authorization is required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by American Health Advantage of Pennsylvania (HMO I-SNP) with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical, substance abuse, and blood services. Prior authorization is required for outpatient hospital, observation, and ambulatory surgical center services.
Partial Hospitalization See details
Partial hospitalization is covered under the American Health Advantage of Pennsylvania (HMO I-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
American Health Advantage of Pennsylvania (HMO I-SNP) covers ambulance services with a 20% coinsurance and no copay, requiring prior authorization for both ground and air transport. Transportation services are partially covered with no copay and no coinsurance for up to 36 one-way trips per year to any health-related location, though transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Emergency services are partially covered by American Health Advantage of Pennsylvania (HMO I-SNP), as worldwide emergency, urgent care, and emergency transportation services are not covered. For covered domestic emergency and urgent care, there is no copay but a 20% coinsurance applies (up to $115 and $40 per visit, respectively) which counts toward your deductible and is waived if you are admitted to the hospital within 1 day.
Primary Care See details
Primary care, telehealth, and opioid treatment services under American Health Advantage of Pennsylvania (HMO I-SNP) are covered with no copay and no coinsurance. Specialist, therapy, mental health, and podiatry services feature no copay and range from no coinsurance to 20% coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by American Health Advantage of Pennsylvania (HMO I-SNP) with no copays and no coinsurance for covered benefits, which include Medicare-covered preventive care, kidney disease education, and in-home support services. However, several benefits are not covered, including an annual physical exam, fitness benefits, health education, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by American Health Advantage of Pennsylvania (HMO I-SNP) with no deductible. Routine hearing exams require a 20% coinsurance and no copay, while fitting evaluations and prescription hearing aids (up to $500 per ear annually) have no copay and no coinsurance. Over-the-counter (OTC) hearing aids, along with inner-ear, outer-ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
American Health Advantage of Pennsylvania (HMO I-SNP) offers partially covered vision services, as other eye exam services are not covered. Covered services include one routine eye exam per year with no copay and 20% coinsurance, and up to $300 annually for eyewear with no copay, though contact lenses require 20% coinsurance.
Dental Services See details
American Health Advantage of Pennsylvania (HMO I-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance. Routine and comprehensive dental services, including oral exams, cleanings, x-rays, fluoride, restorative services, endodontics, periodontics, prosthodontics, oral surgery, and orthodontics, are not covered.
Home Infusion bundled Services See details
American Health Advantage of Pennsylvania (HMO I-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry no copay and a 0% to 20% coinsurance.
Dialysis Services See details
American Health Advantage of Pennsylvania (HMO I-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
American Health Advantage of Pennsylvania (HMO I-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment, supplies, and therapeutic shoes are also covered under this plan with no copay and no coinsurance.
Diagnostic and Radiological Services See details
American Health Advantage of Pennsylvania (HMO I-SNP) covers diagnostic and radiological services, which require prior authorization. Diagnostic procedures and tests require a copayment and 20% coinsurance, while lab services feature no copay. Radiological services, including outpatient X-rays, diagnostic, and therapeutic services, require no copay and have a 20% coinsurance.
Home Health Services See details
Home health services are covered by American Health Advantage of Pennsylvania (HMO I-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by American Health Advantage of Pennsylvania (HMO I-SNP) with no copay and prior authorization required, though only some services are covered as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
American Health Advantage of Pennsylvania (HMO I-SNP) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. Prior authorization is required for this benefit, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered by American Health Advantage of Pennsylvania (HMO I-SNP), as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved