Capital Health Plan Giveback Advantage (HMO) Medicare Advantage Plan H5938-009 • 2026 • Gadsden County, FL

Capital Health Plan Giveback Advantage Overview

Plan Overview for Capital Health Plan Giveback Advantage

Capital Health Plan Giveback Advantage is a Medicare Advantage Prescription Drug (MAPD) Health Maintenance Organization (HMO) plan that includes hospital, medical, and prescription drug coverage under Medicare Parts A and B. The monthly premium is $0.00, and services are generally covered when received from in-network providers, except in emergency situations. The annual Part D deductible is $250.00.

Primary care visits have a $0 copay, specialist visits come with a $30 copay, urgent care services carry a $20 copay, and ambulance transportation is $290 copay. These costs apply toward the maximum out-of-pocket (MOOP) limit of $6700.00. After this limit is reached, in-network services are fully covered for the remainder of the year.

This plan is listed by CMS under Plan ID H5938-009. Cost-sharing details for key services are provided below.

Cost Sharing Expenses

Capital Health Plan Giveback Advantage has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H5938-009.

Certain preventive services are covered 100% by Capital Health Plan Giveback Advantage as a Part B benefit.

Prescription Drug Coverage

Capital Health Plan Giveback Advantage includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Special Needs Plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $250.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Capital Health Plan starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Capital Health Plan Giveback Advantage may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

CMS Star Ratings

The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.