Medicare Advantage · HMO
PruittHealth Premier
Plan year 2026

PruittHealth Premier Advantage (HMO I-SNP) H3291-003

Monthly premium
$0
+ your Part B premium
Max out-of-pocket
$5,900
in-network annual cap
Primary care
$0
per visit copay
Specialist
$15
per visit
Eligibility required for this I-SNP
The plan must verify that, for 90 days or longer, you have needed or are expected to need the level of care provided in a qualifying institution. Some plans also serve people who need an equivalent institutional level of care while living in the community. Review the official plan documents for the residence, care-level, and enrollment requirements.
Medical coverage is different from long-term room and board

An I-SNP coordinates Medicare-covered care for members who meet its institutional eligibility rules. That eligibility does not mean Medicare pays for long-term custodial care or an ongoing nursing-home stay. Medicare may cover short-term skilled nursing care when its coverage requirements are met; Medicaid, long-term-care insurance, or personal funds may cover other long-term-care costs.

Research nearby nursing homes
The nursing-home finder shows CMS facility information. It does not confirm that a facility participates in this plan. Confirm participation with both the facility and the plan before enrolling.
Extra benefits for members who qualify
  • Food and produce benefit
These benefits are not available to every member. Even if you have a listed chronic condition, the plan must confirm that you meet its coverage criteria. See the Evidence of Coverage for complete rules.

Your costs at a glanceIn-network, for the 2026 plan year

Rx deductible
$0
Inpatient hospital
Days 1-7: $311/day, Days 8-90: $0/day
Inpatient mental health
Days 1-7: $311/day, Days 8-90: $0/day
Outpatient surgery
$40
–$298
Emergency room
$90
Urgent care
$35

What's included, and what it's actually worth5 benefits included. Tap any card for the detail

Dental

$2,500/yr preventive dental allowance
Details$2,500/yr preventive dental allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.

Hearing

$2,500hearing aid allowance per 2 years
Hearing aid allowance$2,500 hearing aid allowance per 2 years
This is a supplemental benefit with plan-specific limits. See plan documents for details.

Vision

$500/yr eyewear allowance
Eyewear allowance$500/yr eyewear allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.
See more details about this plan
Doctor Visits: PCP$0 copay
In-network$0 copay per visit
Doctor Visits: Specialist$15 copay
In-network$15 copay per visit
Inpatient Hospital$311/day, days 1–7
In-networkDays 1-7: $311/day, Days 8-90: $0/day
Outpatient Surgery$40–$298
In-network$40–$298 per procedure
Mental HealthDays 1-7: $311/day, Days 8-90: $0/day
Inpatient psychiatricDays 1-7: $311/day, Days 8-90: $0/day
Transportation48 one-way trips/year
Trips per year48 one-way trips/year
MealsMeal benefit

Your coverageCheck your coverageFrom the doctors and prescriptions you added

Your plan's drug tiers30-day retail · after any applicable deductible

Tier 1
$0
Preferred Generic
Tier 2
$7
Generic
Tier 3
$45
Preferred Brand
Tier 4
$95
Non-Pref Brand
Tier 5
33%
Specialty

Our take

Where this plan shines

This plan has a $0 monthly premium.
See your primary doctor for $0.
The specialist copay ($15) is among the more affordable options.
No separate drug deductible.

Things to know before you enroll

This plan’s out-of-pocket maximum is above the national median.
Network restriction — you’ll need to use in-network providers except in emergencies.
Limited coverage while traveling outside the plan’s service area.
Questions? Talk to a licensed agent at1-866-764-3312 (TTY: 711)

Plan documents

Plan questions

Common questions about PruittHealth Premier Advantage (HMO I-SNP)

What does PruittHealth Premier Advantage (HMO I-SNP) cover?

PruittHealth Premier Advantage (HMO I-SNP) is an Institutional Special Needs Plan, a Medicare Advantage plan for people whose qualifying institutional level of care the plan verifies. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 5 formulary tiers. Published supplemental benefits include dental ($2,500/yr preventive dental allowance), vision ($500/yr eyewear allowance), hearing ($2,500 hearing aid allowance per 2 years), and transportation (48 one-way trips/year). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

Learn about Medicare Advantage

How much does PruittHealth Premier Advantage (HMO I-SNP) cost in 2026?

The published 2026 monthly plan premium for PruittHealth Premier Advantage (HMO I-SNP) is $0. 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 $0. The in-network medical out-of-pocket maximum is $5,900; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $15. These figures are plan data, not a personal yearly-cost estimate.

Understand Medicare drug-cost limits

Can I use my current doctors with PruittHealth Premier Advantage (HMO I-SNP)?

CMS lists PruittHealth Premier Advantage (HMO I-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 doctors

Who is eligible for PruittHealth Premier Advantage (HMO I-SNP)?

PruittHealth Premier Advantage (HMO I-SNP) is listed in the current plan record as a I-SNP. The plan must verify that, for 90 days or longer, you have needed or are expected to need the level of care provided in a qualifying institution. Some plans also serve people who need an equivalent institutional level of care while living in the community. Review the official plan documents for the residence, care-level, and enrollment requirements.

Learn about Special Needs Plans

What does PruittHealth Premier Advantage (HMO I-SNP) cover for people who need institutional care?

PruittHealth Premier Advantage (HMO I-SNP) is identified in the current plan record as an Institutional Special Needs Plan. The record identifies Part D prescription drug coverage. It also lists dental ($2,500/yr preventive dental allowance), vision ($500/yr eyewear allowance), hearing ($2,500 hearing aid allowance per 2 years), transportation (48 one-way trips/year), and meals (Meal benefit). The page data does not describe facility-specific therapy, nursing, or care-coordination arrangements. Confirm covered services, participating facilities, benefit limits, and coordination responsibilities in the official plan documents before enrolling.

When can I enroll in PruittHealth Premier Advantage (HMO I-SNP)?

PruittHealth Premier Advantage (HMO I-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 I-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 periods

More plan options

Browse the full 2026 Institutional Special Needs Plan directory. This plan is offered in Georgia. Plan availability can vary by county.

Helpful next steps

PruittHealth Premier Advantage H3291-003 (HMO I-SNP) — 2026