Prime Health Complete (HMO D-SNP) H2926-001
These definitions are educational. They do not confirm which Medicaid categories this specific plan accepts.
Medicare Savings Programs are run by each state. The 2026 federal baseline monthly income limits are:
- QMB: $1,350 for one person or $1,824 for a married couple
- SLMB: $1,616 for one person or $2,184 for a married couple
- QI: $1,816 for one person or $2,455 for a married couple
- $65/month food and produce allowance
Your costs at a glanceIn-network, for the 2026 plan year
This plan is for people with Medicaid. What you pay depends on your Medicaid level: with QMB, your share of Medicare-covered services is covered; with full Medicaid benefits, your state may also cover Medicaid-covered services. Your state Medicaid office can confirm your level — or call us at 1-866-764-3312 (TTY 711) and a Licensed Medicare Advisor will help confirm it and discuss this plan's details with you. If you lose Medicaid eligibility, you may be billed the plan's cost sharing.
What's included, and what it's actually worth3 benefits included. Tap any card for the detail
Meals
$420/yr meal benefit
OTC allowance
$25/month OTC allowance
See more details about this plan
Doctor Visits: PCP$0 copay
Doctor Visits: Specialist$0 copay
Outpatient Surgery$0 copay
VisionRoutine vision benefit
Your coverageCheck your coverageFrom the doctors and prescriptions you added
Your plan's drug tiers30-day retail · after any applicable deductible
Our take
Where this plan shines
Things to know before you enroll
Plan documents
Plan questions
Common questions about Prime Health Complete (HMO D-SNP)
What does Prime Health Complete (HMO D-SNP) cover?
Prime Health Complete (HMO D-SNP) is a Dual Eligible Special Needs Plan, a Medicare Advantage plan for people who have Medicare and a Medicaid category the plan accepts. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 1 formulary tiers. Published supplemental benefits include vision (Routine vision benefit), over-the-counter (OTC) ($25/month OTC allowance), and meals ($420/yr meal benefit). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.
Learn about Medicare AdvantageHow much does Prime Health Complete (HMO D-SNP) cost in 2026?
The published 2026 monthly plan premium for Prime Health Complete (HMO D-SNP) is $39.70. The standard Part B premium is $202.90/month in 2026 for most people; assistance may pay it for some members. The listed Part D deductible is $615. The in-network medical out-of-pocket maximum is $9,250; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $0. Member costs can depend on the Medicaid category the plan accepts and verifies. These figures are plan data, not a personal yearly-cost estimate.
Understand Medicare drug-cost limitsCan I use my current doctors with Prime Health Complete (HMO D-SNP)?
CMS lists Prime Health Complete (HMO D-SNP) as a HMO plan. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.
Check your doctorsDo I qualify for Prime Health Complete (HMO D-SNP)?
Prime Health Complete (HMO D-SNP) is listed in the current plan record as a D-SNP. You must be entitled to Medicare Part A, enrolled in Part B, and have a Medicaid category this plan accepts. The plan must verify your Medicaid status. Eligibility alone does not create a year-round right to enroll.
Learn about Medicare Savings ProgramsWhat extra benefits does Prime Health Complete (HMO D-SNP) offer for dual-eligible members?
The current plan record for Prime Health Complete (HMO D-SNP) lists vision (Routine vision benefit), over-the-counter (OTC) ($25/month OTC allowance), and meals ($420/yr meal benefit). Member costs can depend on the Medicaid category the plan accepts and verifies. The record identifies Part D prescription drug coverage. Review the plan documents for benefit limits, eligibility rules, and how Medicare and Medicaid coverage work together.
When can I enroll in Prime Health Complete (HMO D-SNP)?
Prime Health Complete (HMO D-SNP) is a 2026 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. Because this is a D-SNP, the plan must also verify its eligibility requirements. A qualifying circumstance may create a Special Enrollment Period, but eligibility alone does not guarantee a year-round right to enroll. Confirm the enrollment window and effective date that apply to you before changing coverage.
Review Medicare enrollment periodsMore plan options
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