Aspire Health Advantage (HMO) 2024 Benefit Details for Plan H8764-001-0 by Aspire Health
Aspire Health Advantage is a HMO Medicare Advantage plan, with Part D benefits, available in 2024. This Aspire Health plan offers the same basic benefits as Original Medicare, but out-of-pocket costs differ. It may also include additional, valuable benefits not covered by Part A or Part B.
Plan Basics | |
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Plan ID: | H8764 001 0 |
Plan Type: | Local HMO |
Plan Year: | 2024 |
Premium: | $142.00/mo Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | $3,800/yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Enhanced, $0.00 deductible |
Rx Gap Coverage: | Yes |
Supplemental Benefits: | None |
Availability: | See List |
Insured By: | Aspire Health |
Summary of Benefits |
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Health Plan Cost Sharing
This Aspire Health Medicare Advantage plan has cost-sharing. These are costs you must pay out-of-pocket when you use approved health services.
NOTE: Most preventive services are covered 100% by the plan as a Part B benefit.
The following table summarizes the most common out-of-pocket costs you will incur if you join this plan unless you go out-of-network:
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $0 |
Specialist: | $25 Copay Prior Authorization Required |
Wellness programs (e.g., fitness, nursing hotline): | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $25 Copay |
Routine foot care: | Not Covered |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $10 Copay |
Routine chiropractic care: | Not Covered |
Emergency Care / Urgent Care | |
Emergency room care: | $90 Copay |
Urgent care: | $0 |
Ground ambulance: | $300 Copay |
Inpatient hospital coverage: | $250.00 per day for days 1 through 6 $0.00 per day for days 7 and beyond |
Outpatient hospital coverage: | $275 Copay Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $100.00 per day for days 21 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $15 Copay |
Outpatient group therapy visit with a psychiatrist: | $15 Copay |
Inpatient hospital - psychiatric: | $250.00 per day for days 1 through 6 $0.00 per day for days 7 and beyond |
Outpatient group therapy visit: | $15 Copay |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $15 Copay Prior Authorization Required |
Occupational therapy visit: | $15 Copay Prior Authorization Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | $0 |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Prior Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | $150 Copay Prior Authorization Required |
Lab services: | $10 Copay Prior Authorization Required |
Outpatient x-rays: | $10 Copay Prior Authorization Required |
Diagnostic tests and procedures: | $10 Copay Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our Aspire Health Advantage Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits Aspire Health includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | Not Covered |
Hearing aids (In-Network) | Not Covered |
Hearing exam (In-Network) | Not Covered |
Vision | |
Eyeglasses (frames and lenses) (In-Network) | Not Covered |
Routine eye exam (In-Network) | Not Covered |
Contact lenses (In-Network) | Not Covered |
Additional Benefits
None specified.
Prescription Drug Plan Costs & Benefits
Aspire Health Advantage includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. LIS, also known as Extra Help, is a Social Security program that helps people with limited income and resources lower or cut Part D costs.
The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $30.10 |
Supplemental Part D Premium: | $36.00 |
Total Part D Premium: | $66.10 |
Part D Premium with Full LIS Assistance: | $36.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. You must pay this amount at the pharmacy before Aspire Health begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Aspire Health Advantage has out-of-pocket costs that you must pay when you pick up your prescriptions.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | N/A | $4.00 copay |
2 (Generic) | N/A | $8.00 copay |
3 (Preferred Brand) | N/A | $45.00 copay |
4 (Non-Preferred Drug) | N/A | $95.00 copay |
5 (Specialty Tier) | N/A | 33% |
6 (Select Diabetic Drugs) | N/A | $11.00 copay |
2024 CMS 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 based on a 5-star rating system. Here are the most recent CMS ratings for Aspire Health Advantage.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
On most measures, this Medicare Advantage HMO plan performs well. But it's good to know where it could use some improvement. Aspire Health Advantage does an excellent job keeping its members healthy through its preventive care program with proactive screenings, tests, and vaccines. When it comes to helping members manage their chronic health conditions, this plan does an average job.
The member experience with this Aspire Health plan is average. Complaints and changes in performance with this plan are average. If you're concerned about how this health plan will treat you when you call for assistance, don't be. Members say it's good.
Aspire Health Advantage does not offer any additional popular benefits, like dental, vision, or hearing.
With an added premium of $142.00 dollars per month, prospective members are advised to carefully weigh the value of the plan's additional benefits. While not the lowest, Aspire Health Advantage's maximum out-of-pocket (MOOP) limit ($3,800/yr) won't cost you more than Original Medicare for a 5-day stay in the hospital. Even though members have copays with this health plan, they don't have to worry about a deductible.
Plan Availability
Aspire Health Advantage (H8764-001-0) is available in the following locations (click to open):
Additional Medicare Advantage Plan Options
The Medicare Advantage program offers a myriad of options, including these plans:
- H8764-004-0: Aspire Health Protect (HMO)
- H8764-003-0: Aspire Health Value (HMO)
- H8764-002-0: Aspire Health Plus (HMO-POS)
- H8764-001-0: Aspire Health Advantage (HMO)
Contact Aspire Health
Plan Website: | http://www.aspirehealthplan.org |
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Formulary Information: | http://www.aspirehealthplan.org |
Pharmacy Information: | Aspire Health Pharmacy Page |
Prospective Members: | (888)839-3991 |
TTY Users: | 711 |
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 Advantage program on www.medicare.gov or call 1-800-MEDICARE.
Medicare Part C Compatibility
Medicare Part C plans (HMO, PPO, PFFS) typically do not work with other types of health insurance. If you have Medicare Part A and/or Part B and decide to join a Part C plan, you will be removed from Original Medicare.
If you are enrolled in a Part C plan with prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D plan, regardless of your chosen insurance company.
You cannot be enrolled in a Part C health plan and simultaneously hold Medicare Supplement Insurance (Medigap). Medicare Supplement plans are only compatible with Medicare Parts A and B.
Veterans enrolled in a Part C plan who also have VA Health Benefits may be able to receive care at their local VA healthcare facility. However, depending on the plan, the plan may or may not cover VA out-of-pocket healthcare or drug costs. Speak with a licensed insurance agent to discuss your options.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- Aspire Health, http://www.aspirehealthplan.org, Last Accessed February 20, 2024
- Medicare.gov, "Your health plan options", Last Accessed February 20, 2024
- Medicare.gov, "How Original Medicare Works", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You", Last Accessed February 19, 2024
- Medicare.gov, "What Medicare Covers", Last Accessed February 7, 2023
- CMS.gov, Landscape Source Files, Last Accessed February 21, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed February 21, 2024
- CMS.gov, Plan Benefits Package, Last Accessed February 21, 2024
About This H8764-001-0 Plan Detail Page
The data on this Aspire Health Advantage plan detail page is derived from the 2024 Landscape Source Files, Plan Benefit Package, and Medicare Part C and Part D Performance Data published by CMS.
The author interprets these files, and their associated data dictionary, with great care, making every attempt to communicate the data submitted by Aspire Health to CMS as clearly and accurately as possible. Given the complexity of the data, the author recommends that all potential enrollees request an official Summary of Benefits from Aspire Health, at (888)839-3991, prior to enrollment.