AgeRight Advantage Premier Health Plan (C-SNP) Plan Details for Benton County, OR
This page provides coverage and cost details for AgeRight Advantage’s H1372-003-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.
*This plan is new and has not yet been rated by CMS.
This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
Individuals must meet all Chronic or Disabling Condition SNP qualification requirements to join this C-SNP plan.
AgeRight Advantage Premier Health Plan Basic Plan Details
- Plan ID
- H1372-003-0
- Plan Type
- HMO C-SNP
- Plan Year
- 2025
- Premium
- $55.00/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 5,000.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Enhanced
$300.00 deductible - Supplemental Benefits
- Vision, Hearing
- Availability
- Benton County, OR
- Insured By
- AgeRight Advantage
| Summary of Benefits |
|---|
Health Plan Out-of-Pocket Costs
The following table is a summary of the most common out-of-pocket costs you will incur if you join this AgeRight Advantage plan:
Doctor's Office Visits
- Primary
- Not Covered
- Specialist
- $20 Copay
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $90 Copay
- Urgent care
- 20% Coinsurance
- Ground ambulance
- $250 Copay
- Inpatient hospital care
- $325.00 per day for days 1 through 7
$0.00 per day for days 8 and beyond - Skilled Nursing Facility
- Unknown
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- $0 Copay
- Routine Foot Care
- Not Covered
Chiropractic Care
- Medicare-covered chiropractic
- 20% Coinsurance
Prior Authorization Required - Routine chiropractic
- Not Covered
Mental Health Services
- Outpatient individual therapy
- 20% Coinsurance
- Outpatient group therapy
- 20% Coinsurance
- Inpatient psychiatric hospital care
- $325.00 per day for days 1 through 7
$0.00 per day for days 8 and beyond
Rehabilitation Services
- Physical therapy and speech and language therapy
- Not Covered
- Occupational therapy
- Not Covered
Medical Equipment and Supplies
- Diabetes supplies
- Not Covered
- Durable medical equipment
- 20% Coinsurance
Prior Authorization Required - Prosthetics
- 20% Coinsurance
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- 20% Coinsurance
Prior Authorization Required - Lab services
- Not Covered
- Outpatient x-rays
- 20% Coinsurance
Prior Authorization Required - Diagnostic tests and procedures
- 20% Coinsurance
Prior Authorization Required
Medicare Part B Drugs
- Chemotherapy
- 20% Coinsurance
- Other Part B drugs (Medicare-covered)
- 20% Coinsurance
Dental Services
- Medicare Covered Preventive Dental
- 20% Coinsurance
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
- $1,000.00 (Every year)
Hearing Aids and Services
- Fitting/evaluation
- Covered
Limits may apply - Hearing aids
- Not Covered
- Hearing exam
- Covered
Limits may apply
Vision Services
- Medicare-covered eye exam
- Routine eye exam
- Covered
Limits may apply - Eyewear benefits
- None
Prescription Drug Costs & Benefits
AgeRight Advantage Premier Health Plan includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.
As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.
Prescription Drug Premium with Extra Help
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 premium assistance details with Extra Help.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| Low Income Premium Subsidy CMS Pays: | $26.20 |
| Low Income Subsidy Premium: | $28.80 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Deductible
The Medicare Part D annual deductible with this plan is $300.00. You must pay this amount at the pharmacy before AgeRight Advantage begins paying its share.
Prescription Drug Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, AgeRight Advantage Premier Health Plan has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic* | $0.00 | $0.00 |
| Generic | $15.00 | $15.00 |
| Preferred Brand | $45.00 | $45.00 |
| Non-Preferred Brand | $95.00 | $95.00 |
| Specialty Tier | 29.00% | 29.00% |
| *The Part D deductible does not apply. | ||
CMS Rating Marks
Each year Medicare rates C-SNP plans, using a 5-star rating system, in nine major categories. These ratings are designed to help you understand the quality of care and service you can expect if you qualify and choose to join AgeRight Advantage Premier Health Plan .
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
| Managing Chronic (Long Term) Conditions | Not enough data available |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | Not enough data available |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Not enough data available |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify to Enroll in
AgeRight Advantage Premier Health Plan
To be eligible to enroll in AgeRight Advantage Premier Health Plan , you must meet these requirements:
- You are eligible for Medicare;
- You live in Benton County (the plan’s service area); and
- You have been diagnosed with one or more severe or disabling chronic conditions.
A disabling chronic condition (disease) is one that lasts one or more years and requires ongoing medical attention and/or limits activities of daily living. They include:
- Autoimmune disorders
- End-stage renal disease
- Cancer
- Cardiovascular disorders
- Hematologic disorders
- HIV/AIDS
- Chronic heart failure
- Chronic lung disorders
- Neurologic disorders
- Dementia
- Diabetes
- End-stage liver disease
- Neurologic disorders
- Stroke
- Mental health conditions
Additional C-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
Contact Us About AgeRight Advantage
| Website: | AgeRight Advantage Plan Page (opens in new tab) |
|---|---|
| Providers: | AgeRight Advantage Providers Page (opens in new tab) |
| Formulary: | AgeRight Advantage Formulary Page (opens in new tab) |
| Pharmacy: | AgeRight Advantage Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (844)854-6885 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (844)854-6885 |
| New Member Part D 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.
Health Plan Compatibility
Medicare Advantage Special Needs Plans (SNPs) are generally incompatible with most other health insurance options. Enrolling in an SNP plan while having Medicare Part A and/or Medicare Part B will result in disenrollment from Original Medicare. Additionally, it is not possible to simultaneously hold a Medicare Supplement Insurance policy and be part of an SNP plan.
With a D-SNP, members keep the same Medicaid plan and Medicaid benefits. If you are a Veteran and have VA Health Benefits, you may be able to care from your local VA hospital.
Citations & References
- AgeRight Advantage, http://www.agerightadvantage.com, Last Accessed October 13, 2024
- Medicaid.gov, "Medicaid & CHIP in Oregon", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
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