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VIVA Medicare Infirmary Health Advantage (HMO)

H0154 - 020 - 0

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VIVA Medicare Infirmary Health Advantage (HMO) is a Medicare Advantage Plan by VIVA Medicare.

This page features plan details for 2025 VIVA Medicare Infirmary Health Advantage (HMO) H0154 – 020 – 0 available in Baldwin and Mobile Counties.

Locations

VIVA Medicare Infirmary Health Advantage (HMO) is offered in the following locations.

Alabama

Baldwin County, Alabama

Mobile County, Alabama

Click to see more locations

Plan Overview

VIVA Medicare Infirmary Health Advantage (HMO) offers the following coverage and cost-sharing.

Insurer:	VIVA Medicare
Health Plan Deductible:	$0
MOOP:	$6,500 In-network
Drugs Covered:	Yes

Ready to sign up for VIVA Medicare Infirmary Health Advantage (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

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.

VIVA Medicare Infirmary Health Advantage (HMO) qualifies for a monthly Medicare Give Back Benefit of $33.00.

Premium Reduction:

$33.00

Premium Breakdown

VIVA Medicare Infirmary Health Advantage (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	$33.00	$

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

VIVA Medicare Infirmary Health Advantage (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:	$0.00
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 $0.00 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	Std. Pharm	Pref. Mail	Std. Mail
1) Preferred Generic			$4.00 Copay
2) Generic	$12.00 Copay	$10.00 Copay	$12.00 Copay
3) Preferred Brand	$47.00 Copay	$39.50 Copay	$47.00 Copay
4) Non-Preferred Drug		46.00% Coinsurance	46.00% Coinsurance
5) Specialty Tier

60 Day

Tier	Std. Pharm	Pref. Mail	Std. Mail
1) Preferred Generic			$8.00 Copay
2) Generic	$24.00 Copay	$20.00 Copay	$24.00 Copay
3) Preferred Brand	$94.00 Copay	$78.50 Copay	$94.00 Copay
4) Non-Preferred Drug		46.00% Coinsurance	46.00% Coinsurance
5) Specialty Tier

90 Day

Tier	Std. Pharm	Pref. Mail	Std. Mail
1) Preferred Generic			$12.00 Copay
2) Generic	$30.00 Copay	$24.00 Copay	$36.00 Copay
3) Preferred Brand	$117.50 Copay	$94.00 Copay	$141.00 Copay
4) Non-Preferred Drug		46.00% Coinsurance	46.00% Coinsurance
5) Specialty Tier

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

VIVA Medicare Infirmary Health Advantage (HMO) also provides the following benefits.

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

- In-Network: No

Comprehensive Dental

Adjunctive General Services
- In-Network: No Coins – No Co pay (Limits Apply)
Endodontics
- In-Network: No Coins – No Co pay (Limits Apply)
Implant Services
- In-Network: No Coins – No Co pay (Limits Apply)
Maxillofacial Prosthetics
- In-Network: No Coins – No Co pay (Limits Apply)
Oral and Maxillofacial Surgery
- In-Network: No Coins – No Co pay (Limits Apply)
Periodontics
- In-Network: No Coins – No Co pay (Limits Apply)
Prosthodontics, fixed
- In-Network: No Coins – No Co pay (Limits Apply)
Prosthodontics, removable
- In-Network: No Coins – No Co pay (Limits Apply)
Restorative Services
- In-Network: No Coins – No Co pay (Limits Apply)

Diagnostic and Preventive Dental

Dental X-Rays
- In-Network: No Coins – No Copay (Limits Apply)
Fluoride Treatment
- In-Network: No Coins – No Copay (Limits Apply)
Oral Exams
- In-Network: No Coins – No Copay (Limits Apply)
Other Diagnostic Dental Services
- In-Network: No Coins – No Copay (Limits Apply)
Other Preventive Dental Services
- In-Network: No Coins – No Copay (Limits Apply)
Prophylaxis (cleaning)
- In-Network: No Coins – No Copay (Limits Apply)

Diagnostic procedures/lab services/imaging

Diagnostic radiology services (e.g., MRI)
- $10-125 copay (Authorization Required)
Lab services
- $0 copay (Authorization Required)
Outpatient x-rays
- $10 copay (Authorization Required)
Diagnostic tests and procedures
- $0-50 copay (Authorization Required)

Doctor visits

Primary
- $0 copay
Specialist
- $0-15 copay per visit

Emergency care/Urgent care

Urgent care
- $0-40 copay per visit (always covered)
Emergency
- $125 copay per visit (always covered)

Foot care (podiatry services)

Routine foot care
- Not covered
Foot exams and treatment
- $15 copay

Ground ambulance

- $300 copay

Health plan deductible

- $0

Hearing

Hearing aids OTC
- $750-2,850 copay (Limits Apply)
Medicare-Covered Hearing Exam
- $0-15 copay
Fitting/evaluation
- $0 copay (Limits Apply)
Hearing aids
- $500-1,975 copay (Limits Apply)

Inpatient hospital coverage

- $325 per day for days 1 through 6
  $0 per day for days 7 through 90
  $0 per day for days 91 and beyond (Authorization Required)

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

- $6,500 In-network

Medical equipment/supplies

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)
Diabetes supplies
- $0 copay (Authorization Required)

Medicare Part B drugs

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

Mental health services

Inpatient hospital – psychiatric
- $325 per day for days 1 through 6
  $0 per day for days 7 through 90 (Authorization Required)
Outpatient group therapy visit
- $15 copay (Authorization Required)
Outpatient group therapy visit with a psychiatrist
- $15 copay (Authorization Required)
Outpatient individual therapy visit
- $15 copay (Authorization Required)
Outpatient individual therapy visit with a psychiatrist
- $15 copay (Authorization Required)

Optional supplemental benefits

- No

Other health plan deductibles?

- In-Network: No

Outpatient hospital coverage

- $0-325 copay per visit (Authorization Required)

Preventive care

- $0 copay

Rehabilitation services

Physical therapy and speech and language therapy visit
- $15 copay
Occupational therapy visit
- $15 copay

Skilled Nursing Facility

- $0 per day for days 1 through 20
  $196 per day for days 21 through 44
  $0 per day for days 45 through 100 (Authorization Required)

Transportation

- Not covered

Vision

Eyeglass lenses
- $0 copay (Limits Apply)
Upgrades
- $0 copay (Limits Apply)
Contact lenses
- $0 copay (Limits Apply)
Eyeglass frames
- $0 copay (Limits Apply)
Other
- Not covered
Routine eye exam
- $0 copay (Limits Apply)
Eyeglasses (frames and lenses)
- $0 copay (Limits Apply)

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

- Covered