Senior Care Plus: Value Group Plan (HMO)

HOMETOWN HEALTH PLAN, INC. · 2026 plan year

Plan ID H2960-803-000

HMO★ 5 CMS StarsEmployer group plan
MOOP (in-network)
$4,150
MOOP (combined)
—
Monthly premium
Not published
CMS publishes no consumer premium for this plan
Prescription drugs
Included

Offered only through an employer or union retiree plan; premiums are set by the group.

This plan in 2027

Plan information

Contract / Plan / Segment
H2960-803-000
Medical deductible
Medicare Part B deductible ($283 in 2026)

More HOMETOWN HEALTH PLAN, INC. plans in NV

Benefits & cost sharing

Hospital

BenefitIn-network
Inpatient Hospital — AcuteOriginal Medicare cost sharing
Inpatient Hospital — PsychiatricOriginal Medicare cost sharing

Pharmacy

BenefitIn-network
Chemotherapy & Radiation Drugs (Part B)0%-20% coinsurance
Other Part B Drugs0%-20% coinsurance
Part B DrugsSee plan details

Mental Health

BenefitIn-network
Mental Health Specialty ServicesSee plan details
Mental Health — Individual Sessions20% coinsurance
Mental Health — Group Sessions20% coinsurance
Supplemental Health BenefitsSee plan details

Other

BenefitIn-network
Glaucoma ScreeningNo charge
Diabetic Supplies20% coinsurance
Supervised Exercise Therapy (SET)20% coinsurance
Diabetic Therapeutic Shoes & Inserts20% coinsurance
Hearing — Prescription Hearing AidsSee plan details
Pulmonary Rehabilitation — Additional Sessions20% coinsurance
Skilled Nursing Facility (SNF)Original Medicare cost sharing
Cardiac & Pulmonary RehabilitationSee plan details
Cardiac Rehabilitation — Additional Sessions20% coinsurance
Intensive Cardiac Rehabilitation — Additional Sessions20% coinsurance
Emergency Services20% coinsurance (max $140)
Urgently Needed Services20% coinsurance (max $65)
Partial Hospitalization Program20% coinsurance
Intensive Outpatient Program (IOP)$60
Home Health ServicesNo charge
Primary Care Physician Services20% coinsurance
Chiropractic Services20% coinsurance
Occupational Therapy Services20% coinsurance
Physician Specialist Services20% coinsurance
Medical Supplies20% coinsurance
Podiatry Services20% coinsurance
Other Health Care Professional Services20% coinsurance
Psychiatric ServicesSee plan details
Psychiatric Services — Individual Sessions20% coinsurance
Psychiatric Services — Group Sessions20% coinsurance
Physical Therapy & Speech-Language Pathology20% coinsurance
Additional Telehealth Services (Part B)No charge
Opioid Treatment Program ServicesNo charge
Diagnostic Tests & Lab ServicesSee plan details
Diagnostic Procedures & Tests20% coinsurance
Laboratory ServicesNo charge
Radiological ServicesSee plan details
Diagnostic Radiology20% coinsurance
Therapeutic Radiology20% coinsurance
X-Ray Services20% coinsurance
Diabetic Supplies & ServicesSee plan details
Outpatient Hospital Services20% coinsurance
Hospital Observation Services20% coinsurance
Ambulatory Surgical Center (ASC)20% coinsurance
Outpatient Substance Abuse ServicesSee plan details
Substance Abuse — Individual Sessions20% coinsurance
Substance Abuse — Group Sessions20% coinsurance
Outpatient Blood Services20% coinsurance
Ambulance ServicesSee plan details
Ground Ambulance20% coinsurance
Air Ambulance20% coinsurance
Non-Emergency Transportation — Health FacilityNo charge
Durable Medical Equipment (DME)20% coinsurance
Prosthetics & OrthoticsSee plan details
Prosthetic Devices20% coinsurance
Dialysis Services20% coinsurance
Acupuncture$35
Over-the-Counter (OTC) ItemsNo charge
Medicare-Covered Preventive ServicesSee plan details
Annual Physical ExamNo charge
Fitness BenefitNo charge
Kidney Disease Education Services20% coinsurance
Diabetes Self-Management TrainingNo charge
Digital Rectal ExamsNo charge
Welcome to Medicare EKGNo charge
Insulin (Part B)$35
Dental — Medicare-Covered Services20% coinsurance
Vision — Eye Exams20% coinsurance
Vision — Eye ExamsSee plan details
Vision — Routine Eye ExamsNo charge
Vision — Eyewear20% coinsurance
Vision — EyewearSee plan details
Vision — Contact LensesNo charge
Vision — Eyeglasses (Lenses & Frames)No charge
Vision — Eyeglass LensesNo charge
Vision — Eyeglass FramesNo charge
Vision — Eyewear UpgradesNo charge
Hearing — Exams20% coinsurance
Hearing — ExamsSee plan details
Hearing — Routine ExamsNo charge
Hearing — Fitting & Evaluation for Hearing AidNo charge
Hearing — Hearing Aids (All Types)$495-$1,970

Service area

  • NV: 17 counties

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