PrimeTime Health Plan Basic - MA Only (HMO-POS) Medicare Advantage Plan H3664-014 • 2027 • Holmes County, OH
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $3900.00In-network
- Part B Giveback
- −$75.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Holmes County, OH
- Local Enrollment
- 32 beneficiaries in Holmes County
PrimeTime Health Plan Basic - MA Only (HMO-POS) Introduction
CMS Plan ID H3664-014 identifies PrimeTime Health Plan Basic - MA Only, a Medicare Advantage HMO-POS plan offered by PrimeTime Health Plan. The plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes without prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $0.00 medical deductible, and $3900.00 in-network maximum out-of-pocket.
This plan is available to eligible beneficiaries who live in Holmes County, Ohio. CMS reports local enrollment of 32 beneficiaries for this plan in Holmes County. New members can contact the plan at (855)877-1049 (TTY 711) for help and additional plan information.
Compare Similar Plans in Holmes County
Compare this plan with the two most-enrolled HMO-POS plans available in Holmes County, Ohio. Enrollment is based on CMS local enrollment data.
| Plan Detail | PrimeTime Health Plan Basic - MA Only | PrimeTime Health Plan Aultimate | Anthem Medicare Advantage |
|---|---|---|---|
| CMS Plan ID | H3664-014-0 |
H3664-021-0 |
H3655-045-1 |
| Local Enrollment | 32 | 372 | 230 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $3,900.00 | $5,900.00 | $6,500.00 |
| Part B Giveback | −$75.00 reduction | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $40 copay | $65 copay | $45 copay |
| Part D Deductible | Not Applicable | $700.00 | $425.00 |
| CMS Star Rating | 4.5 | 4.5 | 3.5 |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Want to explore more options? Browse all Medicare Advantage plans in Holmes County, or compare Medicare Advantage plans across Ohio, including premiums, out-of-pocket costs, CMS ratings, and enrollment.
Plan Benefits
PrimeTime Health Plan Basic - MA Only includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The tables below outline the most common in-network out-of-pocket costs associated with plan H3664-014.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H3664-014-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $40 copay
Preventive and Wellness Services
- Annual wellness exam
- Not covered
- Telehealth benefit
- In-network: $0-$40 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- In-network: $0 copay
- 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: $250 copay
- Lab services
- In-network: $0-$35 copay
Out-of-network: $0-$35 copay - Outpatient x-rays
- In-network: $100 copay
- Diagnostic tests and procedures
- In-network: $100 copay
Emergency and Urgent Care Services
- Emergency room care
- $140 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $60 copay
- Inpatient hospital care
- In-network:
Tier 1
$275 per day for days 1-6
$0 per day for days 7-90
$0 per stay - Skilled Nursing Facility
- In-network:
Tier 1
$20 per day for days 1-20
$150 per day for days 21-39
$0 per day for days 40-100 - Ground ambulance
- In-network: $200 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $35 copay
- Outpatient group therapy
- In-network: $35 copay
- Inpatient psychiatric hospital care
- In-network:
Tier 1
$275 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $35 copay
- Occupational therapy
- In-network: $35 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: 0%-20% coinsurance
- Durable medical equipment
- In-network: 20% coinsurance
- Prosthetics
- In-network: 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Dental x-rays
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Cleaning
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Periodontics
- In-network: 50% coinsurance
Out-of-network: 50% coinsurance - Endodontics
- In-network: 50% coinsurance
Out-of-network: 50% coinsurance - Restorative services
- In-network: 50% coinsurance
Out-of-network: 50% coinsurance - Implant services
- In-network: 50% coinsurance
Out-of-network: 50% coinsurance - Orthodontics
- In-network: 50% coinsurance
Out-of-network: 50% coinsurance - Oral/Maxillofacial surgery
- In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Contact lenses
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Eyeglass frames only
- Not covered
- Eyeglass lenses only
- Not covered
- Eyeglasses (frames & lenses)
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Upgrades
- Not covered
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 PrimeTime Health Plan Basic - MA Only as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Performance Ratings (Contract ID: H3664)
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for PrimeTime Health Plan
- Website
- PrimeTime Health Plan Plan Page
- Providers
- PrimeTime Health Plan Providers Page
- Formulary
- PrimeTime Health Plan Formulary Page
- Pharmacy
- PrimeTime Health Plan Pharmacy Page
- New Member Health Plan Help
- (855)877-1049
- New Member Health Plan TTY
- 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 |
|---|---|---|
| PrimeTime Health Plan (official source) | http://www.primetimehealthplan.com | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | 25 May, 2025 |
| Medicare.gov | Explore your Medicare coverage options | 25 May, 2025 |
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