Perennial Advantage Freedom (HMO-POS)
Available to residents of Montgomery County, OH for 2026. Contract H8797, plan 003, segment 0.
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- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Montgomery County
- Plan website
- Browse the Perennial Advantage Freedom (HMO-POS) formulary
Renewed, service area expanded for 2026. CMS carries this plan forward from 2025.
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $3,900.00? |
| In- and out-of-network out-of-pocket maximum | $3,900.00 |
| Drug deductible | $90.00Tier 1 and 2 exempt |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO-POS? |
| Contract / plan | H8797-003-0 |
| Offered by | Perennial Advantage |
| Parent organization | Perennial Consortium, LLC |
| Formulary drugs | 3,347 |
| Formulary exception tier | 4? |
| Pharmacy search | www.placeholder.com |
| Member services | (844)788-6986TTY 711 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- 4 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H8797 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $5 copay |
| Other health care professional | 20% coinsurance |
| Additional telehealth services | $0–$35 copay |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | Not covered |
| Kidney disease education | $0 copay |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $60 copay(authorization required) |
| Lab services | $0 copay(authorization required) |
| Diagnostic radiology (e.g. MRI, CT) | $125 copay(authorization required) |
| Therapeutic radiology | 20% coinsurance(authorization required) |
| Outpatient x-rays | $0 copay(authorization required) |
| Emergency and urgent care | |
| Emergency room | $90 copay |
| Urgent care | $55 copay |
| Worldwide emergency coverage | Not covered |
| Worldwide urgent care | Not covered |
| Worldwide emergency transportation | Not covered |
| Hospital care | |
| Inpatient hospital stay | $275 per day for days 1–5; $0 per day for days 6–90(authorization required) |
| Outpatient hospital services | $0–$250 copay(authorization required) |
| Outpatient observation | $100 copay(authorization required) |
| Ambulatory surgical center | 20% coinsurance(authorization required) |
| Outpatient blood services | 20% coinsurance |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per stay(authorization required) |
| Home health care | $0 copay(authorization required) |
| Kidney dialysis | 20% coinsurance |
| Rehabilitation | |
| Occupational therapy | $0–$20 copay(authorization required) |
| Physical therapy and speech-language therapy | $0–$20 copay(authorization required) |
| Cardiac rehabilitation | 20% coinsurance(authorization required) |
| Pulmonary rehabilitation | 20% coinsurance(authorization required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $300 per day for days 1–7; $0 per day for days 8–90(authorization required) |
| Outpatient mental health, individual session | $35 copay |
| Outpatient mental health, group session | $35 copay |
| Psychiatrist, individual session | 20% coinsurance |
| Psychiatrist, group session | 20% coinsurance |
| Partial hospitalization | 20% coinsurance(authorization required) |
| Intensive outpatient program | 20% coinsurance |
| Outpatient substance use, individual session | 20% coinsurance(authorization required) |
| Outpatient substance use, group session | 20% coinsurance(authorization required) |
| Opioid treatment program | $0 copay(authorization required) |
| Ambulance and transportation | |
| Ground ambulance | $260 copay(authorization required) |
| Air ambulance | 20% coinsurance(authorization required) |
| Transportation to plan-approved locations | $0 copay |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | 0% coinsurance |
| Diabetic therapeutic shoes or inserts | 0%–20% coinsurance |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | 20% coinsurance(authorization required) |
| Routine chiropractic care | $20 copay(authorization required, limits apply) |
| Acupuncture | Not covered |
| Foot exams and treatment (Medicare-covered) | $40 copay |
| Routine foot care | $0 copay(limits apply) |
| Dental? | |
| Medicare-covered dental services | 20% coinsurance(authorization required) |
| Oral exams | $0 copay(limits apply) |
| Cleanings | $0 copay(limits apply) |
| Fluoride treatment | $0 copay(limits apply) |
| Dental x-rays | $0 copay(limits apply) |
| Other diagnostic dental services | $0 copay |
| Other preventive dental services | Not covered |
| Comprehensive dental plan limit | $2,500 plan limit every year |
| Restorative services (fillings, crowns) | $0 copay(limits apply) |
| Endodontics (root canals) | $0 copay(limits apply) |
| Periodontics (gum disease) | $0 copay(limits apply) |
| Dentures and other removable prosthodontics | $0 copay(limits apply) |
| Maxillofacial prosthetics | Not covered |
| Implants | $0 copay |
| Bridges and other fixed prosthodontics | $0 copay(limits apply) |
| Oral and maxillofacial surgery | $0 copay(limits apply) |
| Orthodontics | Not covered |
| Adjunctive general services | $0 copay(limits apply) |
| Vision? | |
| Eye exam (Medicare-covered) | 20% coinsurance |
| Routine eye exam | $0 copay(limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | 20% coinsurance(limits apply) |
| Eyewear plan limit | $150 plan limit every year |
| Contact lenses | Not covered |
| Eyeglasses (frames and lenses) | $0 copay(limits apply) |
| Eyeglass lenses | $0 copay(limits apply) |
| Eyeglass frames | $0 copay(limits apply) |
| Eyewear upgrades | $0 copay(limits apply) |
| Hearing? | |
| Hearing exam (Medicare-covered) | 20% coinsurance |
| Routine hearing exam | $0 copay(limits apply) |
| Hearing aid fitting and evaluation | $0 copay(limits apply) |
| Hearing aid plan limit | $1,560 plan limit every year |
| Hearing aids (all types) | $0 copay(limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | Covered (allowance not stated) |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | $0 copay(limits apply) |
| Health education | Not covered |
| Nutritional / dietary benefit | Not covered |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | $0 copay(limits apply) |
| Remote access technologies (web/phone, nurse line) | Not covered |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | $0 copay(limits apply) |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | $0 copay(limits apply) |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $10.00 |
| Tier 3 | $45.00 |
| Tier 4 | $95.00 |
| Tier 5 | 25% |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $10.00 | $10.00 | $10.00 | $30.00 | $30.00 | $30.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $10.00 | $10.00 | $10.00 | $30.00 | $30.00 | $30.00 |
| Tier 3: Preferred Brand | $45.00 | $45.00 | $45.00 | $135.00 | $135.00 | $135.00 |
| Tier 4: Non-Preferred Drug | $95.00 | $95.00 | $95.00 | $285.00 | $285.00 | $285.00 |
| Tier 5: Specialty Tier | 25% | 25% | 25% | n/a | n/a | n/a |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 33 other OH counties
Benefits in plain text
Perennial Advantage Freedom (HMO-POS) (H8797-003-0) is a 2026 HMO-POS Medicare Advantage plan offered by Perennial Advantage, available to residents of Montgomery County, OH.
The monthly premium is $0.00 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $3,900.00.
The combined in- and out-of-network out-of-pocket maximum is $3,900.00.
The drug deductible is $90.00. Tier 1 and 2 exempt.
The plan's formulary lists 3,347 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $10.00; tier 3: $45.00; tier 4: $95.00; tier 5: 25%.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.