PrimeTime Health Plan Employer Group HMO MA-Only (HMO-POS)
AULTCARE HEALTH INSURING CORPORATION · 2027 plan year
Plan ID H3664-802-000
HMOPOS★ 4.5 CMS StarsEmployer group plan
- MOOP (in-network)
- $9,850
- 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.
Plan information
- Contract / Plan / Segment
- H3664-802-000
- Medical deductible
- Medicare Part B deductible (CMS has not yet announced the 2027 amount)
More AULTCARE HEALTH INSURING CORPORATION plans in AL
Benefits & cost sharing
Hospital
| Benefit | In-network |
|---|---|
| Inpatient Hospital — Acute | Original Medicare cost sharing |
| Inpatient Hospital — Psychiatric | Original Medicare cost sharing |
Pharmacy
| Benefit | In-network |
|---|---|
| Part B Drugs | See plan details |
| Chemotherapy & Radiation Drugs (Part B) | 0%-20% coinsurance |
| Other Part B Drugs | 0%-20% coinsurance |
Mental Health
| Benefit | In-network |
|---|---|
| Mental Health Specialty Services | See plan details |
| Mental Health — Individual Sessions | 20% coinsurance |
| Mental Health — Group Sessions | 20% coinsurance |
Other
| Benefit | In-network |
|---|---|
| Skilled Nursing Facility (SNF) | Original Medicare cost sharing |
| Cardiac Rehabilitation — Additional Sessions | 20% coinsurance |
| Intensive Cardiac Rehabilitation — Additional Sessions | 20% coinsurance |
| Pulmonary Rehabilitation — Additional Sessions | 20% coinsurance |
| Supervised Exercise Therapy (SET) | 20% coinsurance |
| Emergency Services | 20% coinsurance (max $115) |
| Urgently Needed Services | 20% coinsurance (max $40) |
| Partial Hospitalization Program | 20% coinsurance |
| Intensive Outpatient Program (IOP) | 20% coinsurance |
| Home Health Services | No charge |
| Primary Care Physician Services | 20% coinsurance |
| Chiropractic Services | 20% coinsurance |
| Occupational Therapy Services | 20% coinsurance |
| Physician Specialist Services | 20% coinsurance |
| Podiatry Services | 20% coinsurance |
| Other Health Care Professional Services | 20% coinsurance |
| Psychiatric Services — Individual Sessions | 20% coinsurance |
| Psychiatric Services — Group Sessions | 20% coinsurance |
| Physical Therapy & Speech-Language Pathology | 20% coinsurance |
| Opioid Treatment Program Services | 20% coinsurance |
| Diagnostic Tests & Lab Services | See plan details |
| Diagnostic Procedures & Tests | 20% coinsurance |
| Laboratory Services | No charge |
| Radiological Services | See plan details |
| Diagnostic Radiology | 20% coinsurance |
| Therapeutic Radiology | 20% coinsurance |
| X-Ray Services | 20% coinsurance |
| Outpatient Hospital Services | 20% coinsurance |
| Hospital Observation Services | 20% coinsurance |
| Ambulatory Surgical Center (ASC) | 20% coinsurance |
| Outpatient Substance Abuse Services | See plan details |
| Substance Abuse — Individual Sessions | 20% coinsurance |
| Substance Abuse — Group Sessions | 20% coinsurance |
| Outpatient Blood Services | 20% coinsurance |
| Ambulance Services | See plan details |
| Ground Ambulance | 20% coinsurance |
| Air Ambulance | 20% coinsurance |
| Durable Medical Equipment (DME) | 20% coinsurance |
| Prosthetics & Orthotics | See plan details |
| Prosthetic Devices | 20% coinsurance |
| Medical Supplies | 20% coinsurance |
| Diabetic Supplies & Services | See plan details |
| Diabetic Supplies | 20% coinsurance |
| Diabetic Therapeutic Shoes & Inserts | 20% coinsurance |
| Diabetic Monitors | 20% coinsurance |
| Dialysis Services | 20% coinsurance |
| Medicare-Covered Preventive Services | See plan details |
| Kidney Disease Education Services | 20% coinsurance |
| Glaucoma Screening | 20% coinsurance |
| Diabetes Self-Management Training | 20% coinsurance |
| Digital Rectal Exams | 20% coinsurance |
| Welcome to Medicare EKG | 20% coinsurance |
| Insulin (Part B) | 0%-20% coinsurance (max $35) |
| Dental — Medicare-Covered Services | 20% coinsurance |
| Vision — Eye Exams | 20% coinsurance |
| Vision — Eyewear | 20% coinsurance |
| Hearing — Exams | 20% coinsurance |
| Cardiac & Pulmonary Rehabilitation | See plan details |
| Psychiatric Services | See plan details |
Service area
- AK: 30 counties
- AL: 67 counties
- AR: 75 counties
- AZ: 15 counties
- CA: 58 counties
- CO: 64 counties
- CT: 8 counties
- DC: 1 county
- DE: 3 counties
- FL: 67 counties
- GA: 159 counties
- HI: 5 counties
- IA: 99 counties
- ID: 44 counties
- IL: 102 counties
- IN: 92 counties
- KS: 105 counties
- KY: 120 counties
- LA: 64 counties
- MA: 14 counties
- MD: 24 counties
- ME: 16 counties
- MI: 83 counties
- MN: 87 counties
- MO: 115 counties
- MS: 82 counties
- MT: 56 counties
- NC: 100 counties
- ND: 53 counties
- NE: 93 counties
- NH: 10 counties
- NJ: 21 counties
- NM: 33 counties
- NV: 17 counties
- NY: 62 counties
- OH: 88 counties
- OK: 77 counties
- OR: 36 counties
- PA: 67 counties
- RI: 5 counties
- SC: 46 counties
- SD: 66 counties
- TN: 95 counties
- TX: 254 counties
- UT: 29 counties
- VA: 133 counties
- VT: 14 counties
- WA: 39 counties
- WI: 72 counties
- WV: 55 counties
- WY: 23 counties
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