PruittHealth Premier Advantage (I-SNP) Costs & Coverage, Cobb County, Georgia
PruittHealth Premier Advantage (I-SNP) Costs & Coverage, Cobb County, Georgia
Discover how PruittHealth Premier Advantage (I-SNP HMO) stands out as a 2025 Special Needs Plan (SNP), offering tailored coverage to fit your individual needs. Dive into this detail page to see how this PruittHealth Premier SNP can support your specific health conditions or financial circumstances.
Available in Cobb County, GA, to qualified residents, PruittHealth Premier Advantage 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.
Plan ID H3291-003-0 Overview | |
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Health Plan ID: | H3291-003-0 |
Medicare Advantage Plan Type: | HMO |
Plan Year: | 2024 |
Monthly Premium: | $20.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Enhanced $0.00 deductible |
Supplemental Benefits: | Vision, Hearing |
Availability: | Cobb County, GA |
Insured By: | PruittHealth Premier |
We're Here to Help You Enroll |
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Health Plan Cost Sharing & Benefits
PruittHealth Premier Advantage is a Health Maintenance Organization (HMO) plan. As an HMO I-SNP member, you typically receive healthcare services through the plan’s local network of providers, with referrals generally required to see specialists and other providers. However, PruittHealth Premier Advantage does cover out-of-network care for emergencies and out-of-area dialysis.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 |
Specialist: | $15 Copay |
Wellness & Preventive Programs: | |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $10 Copay |
Routine Foot Care: | $0 |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $20 Copay Prior Authorization Required |
Routine chiropractic: | $20 Copay Prior Authorization Required |
Emergency and Urgent Care | |
Emergency room care: | $90 Copay |
Urgent care: | $45 Copay |
Ground ambulance: | $285 Copay |
Inpatient hospital care: | $311.00 per day for days 1 through 7 $0.00 per day for days 8 and beyond |
Outpatient hospital care: | $298 Copay Prior Authorization Required |
Skilled Nursing Facility: | Unknown |
Optional supplemental benefits: | Not Covered |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $20 Copay |
Outpatient group therapy: | $20 Copay |
Inpatient psychiatric hospital care: | $311.00 per day for days 1 through 7 $0.00 per day for days 8 and beyond |
Outpatient group therapy: | $20 Copay |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $15 Copay Prior Authorization Required |
Occupational therapy: | $15 Copay Prior Authorization Required |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | $0 |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $225 Copay Prior Authorization Required |
Lab services: | $0 |
Outpatient x-rays: | $15 Copay Prior Authorization Required |
Diagnostic tests and procedures: | $95 Copay Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Supplemental Health Plan Benefits (H3291-003-0)
The following is a summary of the supplemental benefits PruittHealth Premier 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 | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | Covered Limits may apply |
Vision | Maximum vision benefit: | $500.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | Covered Limits may apply |
Routine eye exam (In-Network) | Covered Limits may apply |
Contact lenses (In-Network) | Covered Limits may apply |
Additional Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
PruittHealth Premier 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. The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $8.00 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $8.00 |
Part D Premium with Full LIS Assistance: | $0.00 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. This is the amount you must pay at the pharmacy before PruittHealth Premier begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, PruittHealth Premier Advantage has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | N/A | $0.00 copay |
2 (Generic) | N/A | $7.00 copay |
3 (Preferred Brand) | N/A | $45.00 copay |
4 (Non-Preferred Brand) | N/A | $95.00 copay |
5 (Specialty Tier) | N/A | 33% |
5-Star Rating Marks
The Centers for Medicare & Medicaid Services (CMS) annually rates Medicare Advantage I-SNPs in nine key categories using a 5-star system. These ratings help you gauge the quality of care and service you might receive with this PruittHealth Premier plan.
CMS Measure | Star Rating |
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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 | |
Health Plan Customer Service | Not enough data available |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | Not enough data available |
Drug Safety and Accuracy of Drug Pricing |
Eligibility for Enrollment in PruittHealth Premier Advantage
To enroll in PruittHealth Premier Advantage, you must meet the following three criteria:
- You are eligible for Medicare;
- You reside within the plan’s service area; and
- You require the level of care typically provided in an institutional setting, such as a long-term care nursing facility, for 90 days or more.
If you live at home and need a similar level of skilled care, you may qualify for an Institutional Equivalent Special Needs Plan (IE-SNP).
Before enrolling in PruittHealth Premier Advantage, it’s important to consider the following questions:
- Does the plan's provider network include my nursing home or home care provider?
- What costs should I anticipate with this coverage (premiums, deductibles, copayments)?
- Is there an annual limit on my out-of-pocket expenses?
- Will I be able to continue seeing my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities conveniently located?
- Does the plan cover services I receive from out-of-network providers?
- Will I need a referral to visit a specialist?
- Are my medications included in the Part D plan's formulary?
- What special accommodations does the plan offer for individuals with disabilities?
- What language and cultural accommodations does the plan provide?
Medicare Special Needs Plan Enrollment Periods
After confirming your eligibility for PruittHealth Premier Advantage, it’s essential to understand when you can enroll or make changes to your Medicare plan. The following enrollment periods are key:
- Initial Enrollment Period (IEP): This is your first opportunity to enroll when you become Medicare-eligible.
- Annual Enrollment Period (AEP): The annual window when you can review and adjust your Medicare coverage.
- Special Enrollment Periods (SEPs): Special situations may allow you to enroll or change plans outside of the standard periods.
For comprehensive information on these enrollment periods, learn more here and make well-informed Medicare decisions.
Contact PruittHealth Premier
Call 1-877-388-0596 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Sun 8am-11pm EST) and learn more about this Special Needs Plan and other plans on this site.
You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:
Plan Website: | http://www.pruitthealthpremier.com |
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Formulay Information: | http://www.pruitthealthpremier.com |
Pharmacy Information: | PruittHealth Premier Pharmacy Page |
Prospective Members: | (855)855-0668 |
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.
Plans Offered through Medicare.org
Medicare Advantage and Part D plans and benefits offered are 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.