PrimeTime Health Plan Basic - MA Only (HMO-POS) – H3664-014-0
Coverage, cost, and availability details for PrimeTime Health Plan’s H3664-014-0 Medicare Advantage plan are presented here for 2025.
Health Plan Costs
💰 Monthly Premium, Deductible, Max Out-of-Pocket & Giveback
Monthly Premium: The total monthly premium is $0.00, including drug coverage. You must also pay your standard Medicare Part B premium.
Health Plan Deductible: Some health plans have a deductible (amount you pay before cost-sharing begins). This plan's deductible is $0.00.
Maximum Out-of-Pocket: All Medicare Advantage plans have an annual maximum out-of-pocket (MOOP) limit. This is the most you will pay for standard health services in a year before that plan begins paying all costs. This plan's MOOP is $3,900.00 for in-network services, excluding the cost of your Part D medications.
Part B Giveback: This plan offers a Part B premium giveback of $0.00.
Health Plan Out-of-Pocket Costs
🩺 Doctor’s Office Visits
- Primary: Not Covered
- Specialist: $40 Copay
- NOTE: Certain preventive services are covered 100% by the plan as a Part B benefit.
🏥 Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care: $140 Copay
- Urgent care: $60 Copay
- Ground ambulance: $200 Copay
- Inpatient hospital care: $275.00 per day for days 1 through 6
$0.00 per day for days 7 and beyond - Skilled Nursing Facility: $20.00 per day for days 1 through 20
$150.00 per day for days 21 through 39
$0.00 per day for days 40 and beyond
🦶 Foot Care
- Foot Exams and Treatments (Medicare-covered): $35 Copay
- Routine Foot Care: Not Covered
💆 Chiropractic Care
- Medicare-covered chiropractic: $20 Copay
- Routine chiropractic: Not Covered
🧠 Mental Health Services
- Outpatient individual therapy: $35 Copay
- Outpatient group therapy: $35 Copay
- Inpatient psychiatric hospital care: $275.00 per day for days 1 through 6
$0.00 per day for days 7 and beyond
🏋️ Rehabilitation Services
- Physical therapy and speech and language therapy: $35 Copay
- Occupational therapy: $35 Copay
🧰 Medical Equipment and Supplies
- Diabetes supplies: 20% Coinsurance
Prior Authorization Required - Durable medical equipment: 20% Coinsurance
Prior Authorization Required - Prosthetics: 20% Coinsurance
🔬 Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services: $250 Copay
Prior Authorization Required - Lab services: $35 Copay
Prior Authorization Required - Outpatient x-rays: $100 Copay
Prior Authorization Required - Diagnostic tests and procedures: $100 Copay
Prior Authorization Required
💉 Medicare Part B Drugs
- Chemotherapy: 20% Coinsurance
- Other Part B drugs (Medicare-covered): 20% Coinsurance
Supplemental Benefits
🦷 Dental Services
- Medicare Covered Preventive Dental: $40 Copay
Prior Authorization Required - Oral exam: $0
- Dental x-rays: $0
- Cleaning: $0
- Periodontics: Not Covered
- Endodontics: Not Covered
- Restorative Services: Not Covered
- Maximum dental benefit
- $1,100.00 (Every year)
👂 Hearing Aids and Services
- Fitting/evaluation: Covered
Limits may apply - Hearing aids: Not Covered
- Hearing exam: Not Covered
👓 Vision Services
- Medicare-covered eye exam: $ to $40 Copay
- Routine eye exam: Covered
Limits may apply - Eyewear benefits: None
Prescription Drug Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories using a 5-star rating system. Here are the most recent CMS ratings for PrimeTime Health Plan Basic - MA Only.
Plan Availability
PrimeTime Health Plan Basic - MA Only (H3664-014-0) is available in the following locations (click to open):
Need Help Enrolling?
Call 1-855-728-0510 (TTY 711) to speak with a licensed insurance agent and learn more about this plan and others on this site.
Or enroll online through our trusted and secure platform:
🚀 Enroll Online NowClicking this button will open MedicareEnrollment.com (powered by HealthCompare Insurance Services) and the official PrimeTime Health Plan plan page.
📄 View Plan Contact Information
| Website: | PrimeTime Health Plan Plan Page (opens in new tab) |
|---|---|
| Providers: | PrimeTime Health Plan Providers Page (opens in new tab) |
| New Member Health Plan Help: | (855)877-1049 |
| New Member TTY: | 711 |
🔍 Why This Information Matters
Many Medicare websites only show you their own phone numbers and redirect you to their sales team. We believe you deserve full access to your plan resources — including direct links to the official PrimeTime Health Plan site, provider directories, and support contacts.
That’s why we include this information here, clearly and transparently — so you can research and enroll with confidence.
🛡️ Official Medicare Enrollment Resources
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Part C program on www.medicare.gov or call 1-800-MEDICARE.
Frequently Asked Questions
📘 What does Medicare plan code H3664 014 mean?
PrimeTime Health Plan Basic - MA Only is a Medicare Advantage plan by PrimeTime Health Plan. The code H3664 is the CMS contract ID, whereas 014 is its plan ID.
- Plan Name: PrimeTime Health Plan Basic - MA Only
- Plan Type: HMO-POS
- Premium: $0.00/mo + your monthly Part B premium
- Out-of-Pocket Max: $3,900.00 (in-network)
- Drug Coverage: Does not include Medicare Part D prescription drug coverage.
- CMS Star Rating: 4.5 out of 5
- Contract Year: 2025
This information is based on official CMS data and is provided for educational purposes. Always review your plan’s official documents or contact the provider directly before making enrollment decisions.
📋 What type of plan is H3664 014?
This plan is a HMO-POS — specifically, it's an HMO-POS plan with a Medicare Advantage contract that's offered by PrimeTime Health Plan. It comes with defined provider network rules you should be aware of.
- Plan Marketing Name: PrimeTime Health Plan Basic - MA Only
- Network Type: HMO with a point-of-service option for limited out-of-network coverage
- Referral Requirement: Most care requires referrals, but some services may be available out-of-network without one. Check the benefits section for details.
- Prescription Coverage: Does not include Medicare Part D prescription drug coverage.
Plan types like HMOs and PPOs determine whether you can go out-of-network or need referrals to see specialists.
📦 What benefits are included in H3664 014?
This plan covers all Medicare Part A and Part B services. Depending on the plan, it may also include valuable extras like dental, vision, and hearing benefits.
- Medical Services: Hospital, doctor visits, preventive care
- Prescription Drugs: Not Included
- Dental: No — this plan does not include dental benefits.
- Vision: Yes — vision benefits are included. Review the vision section above for copay and limit details.
- Hearing: Yes — hearing benefits are included. See the coverage details above to learn what services are covered.
Benefit availability may vary by location and plan version. Confirm specific details in your plan's Evidence of Coverage (EOC).