PruittHealth Premier Advantage (HMO I-SNP)

Georgia Institutional Special Needs I-SNP Plan (2025 Plan)


Monthly Premium

Your Cost
$7
by PruittHealth Premier

Additional Coverage

HearingVisionDental

Overall Government Star Rating

(coming soon)

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Plan Name
PruittHealth Premier Advantage (HMO I-SNP)
Insurance Carrier
PruittHealth Premier
Plan Type
Institutional Special Needs Plan (I-SNP)
Network Type
HMO

PruittHealth Premier Advantage (HMO I-SNP) is a Institutional Special Needs Plan (I-SNP), which is available in Georgia and offered by the health insurance company PruittHealth Premier. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$7
Annual Deductible
Coming soon
Max Out-of-Pocket
$5,900
Primary doctor visit
$0 copay
Specialist visit
$15 copay per visit
ER visit
$90 copay per visit (always covered)
Ambulance
$285 copay

PruittHealth Premier Advantage (HMO I-SNP) has a monthly premium cost of $7 per month, with an annual deductible of Coming soon and a maximum out of pocket cost sharing of $5,900 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for PruittHealth Premier Advantage (HMO I-SNP) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

PruittHealth Premier Advantage (HMO I-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. PruittHealth Premier Advantage (HMO I-SNP) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. PruittHealth Premier Advantage (HMO I-SNP) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Limited coverage
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Not covered
Telehealth
Limited coverage

Monthly Premium
$7
Health Portion of Premium
$0
Drug Portion of Premium
$7
Health Plan Deductible
Coming soon
Health Plan Max Out-of-Pocket
$5,900 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$15 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$95 copay
Lab services
$0 copay
Diagnostic radiology services (like MRI)
$225 copay
Outpatient x-rays
$15 copay
Emergency care
$90 copay per visit (always covered)
Urgent care
$45 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$311 per day for days 1 through 7
$0 per day for days 8 through 90
Outpatient hospital coverage
$40-298 copay per visit

Skilled nursing facility

Skilled nursing facility
$0 copay

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$285 copay

Therapy services

Occupational therapy visit
$15 copay
Physical therapy & speech & language therapy visit
$15 copay

Mental health services

Outpatient group therapy with a psychiatrist
$20 copay
Outpatient individual therapy with a psychiatrist
$20 copay
Outpatient group therapy visit
$10 copay
Outpatient individual therapy visit
$10 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
20% coinsurance per item
Prosthetics (like braces, artificial limbs)
20% coinsurance per item
Diabetes supplies
$0 copay

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic$0.00 copay$0 copay
Generic$7.00 copay$0 copay
Preferred Brand$45.00 copay$0 copay
Non-Preferred Drug
Specialty Tier33% coinsurance$0 copay

Part B Drugs

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance

Hearing

Hearing exam
20% coinsurance
Fitting/evaluation
$0 copay
Hearing aids - All types
$0 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: $0 copay
Maxillofacial prosthetics
Not covered
Implant services
In-network: $0 copay
Out-of-network: $0 copay
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Orthodontics
Not covered
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
$0 copay

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