MyAdvocate Medicare Advantage GOLD (HMO-POS) Medicare Advantage Plan H0816-001 • 2027 • Otoe County, NE
- Monthly Premium
- $82.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $5500.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $250.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Otoe County, NE
- Local Enrollment
- 0 beneficiaries in Otoe County
MyAdvocate Medicare Advantage GOLD (HMO-POS) Introduction
MyAdvocate Medicare Advantage GOLD is a Medicare Advantage HMO-POS plan offered by MyAdvocate Medicare Advantage. It uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $82.00 monthly premium, $0.00 medical deductible, and $5500.00 in-network maximum out-of-pocket. CMS Plan ID H0816-001 identifies this plan. The 2027 Part D prescription drug deductible is $250.00.
You must live in Otoe County, Nebraska to enroll in this plan. CMS reports 0 beneficiaries enrolled in this plan in Otoe County. For assistance with this plan, new members can call (888)960-5788 (TTY 711).
Compare Similar Plans in Otoe County
Compare this plan with the two most-enrolled HMO-POS plans available in Otoe County, Nebraska. Enrollment is based on CMS local enrollment data.
| Plan Detail | MyAdvocate Medicare Advantage GOLD | Wellcare Giveback | Wellcare Simple |
|---|---|---|---|
| CMS Plan ID | H0816-001-0 |
H1215-003-0 |
H1215-005-0 |
| Local Enrollment | 0 | 26 | 15 |
| Monthly Premium | $82.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $375 | $250 |
| Maximum Out-of-Pocket | $5,500.00 | $8,850.00 | $7,100.00 |
| Part B Giveback | Not offered | −$20.00 reduction | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $35 copay | $55 copay | $50 copay |
| Part D Deductible | $250.00 | $700.00 | $700.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | Not covered | Not covered |
| Hearing | $0 copay | $0 copay | Not covered |
Plan Benefits
MyAdvocate Medicare Advantage GOLD has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H0816-001.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H0816-001-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: 50% coinsurance - Specialist
- In-network: $35 copay
Out-of-network: 50% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: 50% coinsurance - Telehealth benefit
- In-network: $0-$275 copay, 0%-20% coinsurance
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0-$175 copay
Out-of-network: 50% coinsurance - Lab services
- In-network: $0 copay
Out-of-network: 50% coinsurance - Outpatient x-rays
- In-network: $20 copay
Out-of-network: 50% coinsurance - Diagnostic tests and procedures
- In-network: $25 copay
Out-of-network: 50% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $120 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $0-$35 copay
- Inpatient hospital care
- In-network:
Tier 1
$400 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Out-of-network:
50% per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100
Out-of-network:
50% per stay - Ground ambulance
- In-network: $275 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $35 copay
Out-of-network: 50% coinsurance - Outpatient group therapy
- In-network: $35 copay
Out-of-network: 50% coinsurance - Inpatient psychiatric hospital care
- In-network:
Tier 1
$400 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Out-of-network:
50% per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $40 copay
Out-of-network: 50% coinsurance - Occupational therapy
- In-network: $40 copay
Out-of-network: 50% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
Out-of-network: 50% coinsurance - Durable medical equipment
- In-network: 20% coinsurance
Out-of-network: 50% coinsurance - Prosthetics
- In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- In-network: 50% coinsurance
- Endodontics
- In-network: 50% coinsurance
- Restorative services
- In-network: 50% coinsurance
- Implant services
- In-network: 50% coinsurance
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: 50% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- Not covered
- Upgrades
- In-network: $0 copay
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $499-$999 copay
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by MyAdvocate Medicare Advantage GOLD as a Part B benefit.
Prescription Drug Coverage
MyAdvocate Medicare Advantage GOLD 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 Advantage 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.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $22.10 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $22.10 |
| Low-Income Premium Subsidy: | $24.60 |
| Low-Income Premium Subsidy Paid by CMS: | $22.10 |
| Low-Income Subsidy Premium: | $0.00 |
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 MyAdvocate Medicare Advantage starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, MyAdvocate Medicare Advantage GOLD may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $8.00 copay | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 30% coinsurance | Coming soon |
| Specialty Tier | 30% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H0816)
Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | Plan too new to be measured |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
Contact Information for MyAdvocate Medicare Advantage
- Website
- MyAdvocate Medicare Advantage Plan Page
- Providers
- MyAdvocate Medicare Advantage Providers Page
- Formulary
- MyAdvocate Medicare Advantage Formulary Page
- Pharmacy
- MyAdvocate Medicare Advantage Pharmacy Page
- New Member Health Plan Help
- (888)960-5788
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (888)960-5788
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| MyAdvocate Medicare Advantage (official source) | http://www.MyAdvocateMA.com | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Explore your Medicare coverage options | 25 May, 2025 |
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Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.