eternalHealth ForeverMore HMO (HMO) is a Medicare Advantage Plan by eternalHealth.
This page features plan details for 2023 eternalHealth ForeverMore HMO (HMO) H1280 – 002 – 0 available in Middlesex, Suffolk and Worcester Counties.
IMPORTANT: This page features the 2023 version of this plan. See the 2025 version using the link below:
eternalHealth ForeverMore HMO (HMO) is offered in the following locations.
eternalHealth ForeverMore HMO (HMO) offers the following coverage and cost-sharing.
| Insurer: | eternalHealth |
| Health Plan Deductible: | $0.00 |
| MOOP: | $4,500 In-network |
| Drugs Covered: | Yes |
Ready to sign up for eternalHealth ForeverMore HMO (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
| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $164.90 | $0.00 | $35.00 | $0.00 | $ |
eternalHealth ForeverMore HMO (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $170.00 |
| Initial Coverage Limit: | $4,660.00 |
| Catastrophic Coverage Limit: | $7,400.00 |
| Drug Benefit Type: | Enhanced |
| Gap Coverage: | No |
| Formulary Link: | Formulary Link |
| Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
|---|---|---|---|---|
| $35.00 | $43.40 | $34.80 | $26.30 | $17.70 |
After you pay your $170.00 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 $4,660.00. Once you reach that amount, you will enter the next coverage phase.
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $0.00 copay | ||
| 2 (Generic) | $5.00 copay | $5.00 copay | ||
| 3 (Preferred Brand) | $47.00 copay | $47.00 copay | ||
| 4 (Non-Preferred Drug) | $100.00 copay | $100.00 copay | ||
| 5 (Specialty Tier) | 30% | 30% |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | ||||
| 2 (Generic) | ||||
| 3 (Preferred Brand) | ||||
| 4 (Non-Preferred Drug) | ||||
| 5 (Specialty Tier) |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $0.00 copay | ||
| 2 (Generic) | $15.00 copay | $5.00 copay | ||
| 3 (Preferred Brand) | $141.00 copay | $47.00 copay | ||
| 4 (Non-Preferred Drug) | $300.00 copay | $300.00 copay | ||
| 5 (Specialty Tier) |
| Tier | Cost |
|---|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
| Drug Type | Cost Share |
|---|---|
| Generic drugs | $4.15 copay or 5% (whichever costs more) |
| Brand-name drugs | $10.35 copay or 5% (whichever costs more) |
eternalHealth ForeverMore HMO (HMO) also provides the following benefits.
| In-Network: No |
| Diagnostic services: | 50% coinsurance (no limits) (authorization not required) (referral not required) |
| Endodontics: | 50% coinsurance (no limits) (authorization not required) (referral not required) |
| Extractions: | 50% coinsurance (no limits) (authorization not required) (referral not required) |
| Non-routine services: | Not covered (no limits) |
| Periodontics: | 50% coinsurance (no limits) (authorization not required) (referral not required) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | 50% coinsurance (no limits) (authorization not required) (referral not required) |
| Restorative services: | 50% coinsurance (no limits) (authorization not required) (referral not required) |
| Cleaning: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Dental x-ray(s): | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Fluoride treatment: | Not covered (no limits) |
| Oral exam: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Diagnostic radiology services (e.g., MRI): | $100-200 copay (authorization required) (referral not required) |
| Diagnostic tests and procedures: | $0-10 copay (authorization required) (referral not required) |
| Lab services: | $0-10 copay (authorization required) (referral not required) |
| Outpatient x-rays: | $5 copay (authorization required) (referral not required) |
| Primary: | $0 copay |
| Specialist: | $25 copay per visit (authorization not required) (referral required) |
| Emergency: | $95 copay per visit (always covered) |
| Urgent care: | $0-40 copay per visit (always covered) |
| Foot exams and treatment: | $25 copay (authorization not required) (referral required) |
| Routine foot care: | Not covered |
| $250 copay |
| $0.00 |
| In-Network: No |
| Fitting/evaluation: | Not covered (no limits) |
| Hearing aids: | $395-695 copay (no limits) (authorization not required) (referral not required) |
| Hearing exam: | $15 copay (authorization not required) (referral not required) |
| $200 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) (referral not required) |
| $0-250 copay per visit (authorization required) (referral not required) |
| $4,500 In-network |
| Diabetes supplies: | 0-20% coinsurance per item (authorization not 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) |
| Chemotherapy: | 20% coinsurance (authorization required) |
| Other Part B drugs: | 20% coinsurance (authorization required) |
| Inpatient hospital – psychiatric: | $200 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) (referral not required) |
| Outpatient group therapy visit: | $0-25 copay (authorization not required) (referral not required) |
| Outpatient group therapy visit with a psychiatrist: | $0-25 copay (authorization not required) (referral not required) |
| Outpatient individual therapy visit: | $0-25 copay (authorization not required) (referral not required) |
| Outpatient individual therapy visit with a psychiatrist: | $0-25 copay (authorization not required) (referral not required) |
| No |
| $0 copay (authorization not required) (referral not required) |
| Occupational therapy visit: | $30 copay (authorization required) (referral required) |
| Physical therapy and speech and language therapy visit: | $30 copay (authorization required) (referral required) |
| $0 per day for days 1 through 20 $196 per day for days 21 through 61 $0 per day for days 62 through 100 (authorization required) (referral not required) |
| $0 copay (no limits) (authorization required) (referral not required) |
| Contact lenses: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglass frames: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglass lenses: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglasses (frames and lenses): | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Other: | Not covered (no limits) |
| Routine eye exam: | $0 copay (no limits) (authorization not required) (referral not required) |
| Upgrades: | $0 copay (limits may apply) (authorization not required) (referral not required) |
| Covered (authorization required) (referral not required) |
Ready to sign up for eternalHealth ForeverMore HMO (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
Need more information on eternalHealth ForeverMore HMO (HMO)? See 2025 eternalHealth ForeverMore HMO (HMO) at MedicareAdvantageRX.com.
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
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SMID: MULTIPLAN_HCIHNDOGMED01PY25_M
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