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Aspire Health Protect (HMO)

H8764 - 004 - 0

(3 / 5)

Aspire Health Protect (HMO) is a Medicare Advantage Plan by Aspire Health.

This page features plan details for 2025 Aspire Health Protect (HMO) H8764 – 004 – 0 available in Monterey County.

Locations

Aspire Health Protect (HMO) is offered in the following locations.

California

Monterey County, California

Click to see more locations

Plan Overview

Aspire Health Protect (HMO) offers the following coverage and cost-sharing.

Insurer:	Aspire Health
Health Plan Deductible:	$0
MOOP:	$7,000 In-network
Drugs Covered:	Yes

Ready to sign up for Aspire Health Protect (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

Aspire Health Protect (HMO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.

Part B	Part C	Part D	Part B Give Back	Total
$185.00	$0.00	$0.00	$	$

Please Note:

Your Part B premium may differ based on factors including late enrollment, income, and disability status.
You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Aspire Health Protect (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:	$200.00
Drug Out-Of-Pocket maximum:	$2,000.00
Drug Benefit Type:	Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part D	LIS Full
$0.00	$0.00

Initial Coverage Phase

After you pay your $200.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

30 Day

60 Day

90 Day

30 Day

Tier	Pref. Pharm	Std. Pharm	Pref. Mail	Std. Mail
1) Preferred Generic		$9.00 Copay
2) Generic		$18.00 Copay
3) Preferred Brand		$47.00 Copay
4) Non-Preferred Drug		$100.00 Copay
5) Specialty Tier
6) Select Diabetic Drugs		$11.00 Copay

60 Day

90 Day

Tier	Std. Pharm	Std. Mail
1) Preferred Generic	$18.00 Copay	$18.00 Copay
2) Generic	$36.00 Copay	$36.00 Copay
3) Preferred Brand	$94.00 Copay	$94.00 Copay
4) Non-Preferred Drug	$200.00 Copay	$200.00 Copay
5) Specialty Tier
6) Select Diabetic Drugs	$22.00 Copay	$22.00 Copay

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Aspire Health Protect (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

- In-Network: No

Diagnostic procedures/lab services/imaging

Lab services
- $20 copay (Authorization Required)
Diagnostic radiology services (e.g., MRI)
- 10% coinsurance (Authorization Required)
Diagnostic tests and procedures
- $20 copay (Authorization Required)
Outpatient x-rays
- $20 copay (Authorization Required)

Doctor visits

Primary
- $5 copay per visit
Specialist
- $45 copay per visit (Authorization Required)

Emergency care/Urgent care

Emergency
- $110 copay per visit (always covered)
Urgent care
- $25 copay per visit (always covered)

Foot care (podiatry services)

Routine foot care
- Not covered
Foot exams and treatment
- $45 copay

Ground ambulance

- $325 copay

Health plan deductible

- $0

Hearing

Medicare-Covered Hearing Exam
- $45 copay
Hearing aids – inner ear
- Not covered
Hearing aids OTC
- Not covered
Fitting/evaluation
- Not covered
Hearing aids – outer ear
- Not covered
Hearing aids – over the ear
- Not covered

Inpatient hospital coverage

- $385 per day for days 1 through 6
  $0 per day for days 7 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

- $7,000 In-network

Medical equipment/supplies

Diabetes supplies
- $0 copay (Authorization Required)
Durable medical equipment (e.g., wheelchairs, oxygen)
- 20% coinsurance per item (Authorization Required)
Prosthetics (e.g., braces, artificial limbs)
- 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

Other Part B drugs
- 0-20% coinsurance (Authorization Required)
Chemotherapy
- 0-20% coinsurance (Authorization Required)

Mental health services

Outpatient individual therapy visit
- 10% coinsurance (Authorization Required)
Inpatient hospital – psychiatric
- $385 per day for days 1 through 5
  $0 per day for days 6 through 90 (Authorization Required)
Outpatient group therapy visit
- 10% coinsurance (Authorization Required)
Outpatient individual therapy visit with a psychiatrist
- 10% coinsurance
Outpatient group therapy visit with a psychiatrist
- 10% coinsurance

Optional supplemental benefits

- Yes

Other health plan deductibles?

- In-Network: No

Outpatient hospital coverage

- $80-300 copay or 20% coinsurance per visit (Authorization Required)

Preventive care

- $0 copay

Rehabilitation services

Occupational therapy visit
- 10% coinsurance (Authorization Required)
Physical therapy and speech and language therapy visit
- 10% coinsurance (Authorization Required)

Skilled Nursing Facility

- $0 per day for days 1 through 20
  $214 per day for days 21 through 100 (Authorization Required)

Transportation

- $0 copay (Limits Apply, Authorization Required)

Vision

Eyeglass frames
- Not covered
Routine eye exam
- Not covered
Contact lenses
- Not covered
Eyeglass lenses
- Not covered
Other
- Not covered
Upgrades
- Not covered
Eyeglasses (frames and lenses)
- Not covered

Wellness programs (e.g., fitness, nursing hotline)

- Covered

Enhanced Benefits-Option B

Comprehensive Dental

Restorative Services, Endodontics, Periodontics, Prosthodontics, removable, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, Adjunctive General Services
- Monthly Premium: $46.00

Diagnostic and Preventive Dental

Oral Exams, Dental X-Rays, Prophylaxis (Cleaning)
- Monthly Premium: $46.00

Eye Exams

Routine Eye Exams
- Monthly Premium: $46.00

Eyewear

Contact Lenses, Eyeglasses (lenses and frames), Eyeglass lenses, Eyeglass frames, Upgrades
- Monthly Premium: $46.00

Hearing Aids

Prescription Hearing Aids (all types)
- Monthly Premium: $46.00

Hearing Exams

Routine Hearing Exams
- Monthly Premium: $46.00

Meal Benefit

Meal Benefit
- Monthly Premium: $46.00

Transportation Services

Transportation Services – Plan Approved Health-related Location
- Monthly Premium: $46.00