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PrimeTime Health Plan Basic - MA Only (HMO-POS) Medicare Advantage Plan H3664-014 • 2027 • Stark County, OH

CMS Rating: ☆☆☆☆☆ (4.5 out of 5 stars*)
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
Stark County, OH
Local Enrollment
217 beneficiaries in Stark County
Last update:

PrimeTime Health Plan Basic - MA Only (HMO-POS) Introduction

This Medicare Advantage HMO-POS plan, PrimeTime Health Plan Basic - MA Only, is offered by PrimeTime Health Plan and uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network. It comes without prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $3900.00. The plan is identified by CMS Plan ID H3664-014.

Qualifying residents of Stark County, Ohio may enroll in this plan. CMS enrollment data reports 217 plan members in Stark County. New members can call the plan directly at (855)877-1049 (TTY 711) for assistance.

Compare Similar Plans in Stark County

Compare this plan with the two most-enrolled HMO-POS plans available in Stark County, Ohio. Enrollment is based on CMS local enrollment data.

HMO-POS plan comparison for Stark County, Ohio
Plan Detail PrimeTime Health Plan Basic - MA Only Anthem Medicare Advantage Aetna Medicare Signature Care
CMS Plan ID H3664-014-0 H3655-045-4 H0628-005-0
Local Enrollment 217 4,688 3,760
Monthly Premium $0.00 $0.00 $0.00
Medical Deductible $0.00 $0.00 $0.00
Maximum Out-of-Pocket $3,900.00 $4,750.00 $4,900.00
Part B Giveback −$75.00 reduction Not offered Not offered
Primary Care $0 copay $0 copay $0 copay
Specialist $40 copay $35 copay $40 copay
Part D Deductible Not Applicable $425.00 $400.00
CMS Star Rating 4.5 3.5 3.5
Dental $0 copay $0 copay $0 copay
Vision $0 copay $0 copay $0 copay
Hearing $0 copay $0 copay $0 copay

Plan Benefits

Cost-sharing for PrimeTime Health Plan Basic - MA Only includes out-of-pocket expenses for covered healthcare services. The following tables provide a summary of typical in-network out-of-pocket costs for 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.

2027 Medicare Star Ratings for Contract H3664
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 ☆☆☆☆☆
Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher CMS Version
Landscape Source Files Centers for Medicare & Medicaid Services CY2027 Landscape (202609.1)
Medicare Part C & D Performance Centers for Medicare & Medicaid Services 2027 Star Ratings Data Tables
Plan Benefits Package Centers for Medicare & Medicaid Services PBP Benefits-2027
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services 2026-09

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
PrimeTime Health Plan (official source) http://www.primetimehealthplan.com October 4, 2026
CMS.gov Medicare Advantage Plan Fact Sheet 25 May, 2025
AARP.org The Big Choice: Original Medicare vs. Medicare Advantage 25 May, 2025
Medicare.gov Your coverage options 25 May, 2025

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Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.