Medicare Plans

Open Medicare Plan Data.

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

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
See List
Total Enrollment
371 beneficiaries
Last update:

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.

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.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay In-network: $0 copay
Specialist In-network: $40 copay In-network: $40 copay

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam Not covered Not covered
Telehealth benefit In-network: $0-$40 copay In-network: $0-$40 copay
Routine chiropractic Not covered Not covered
Fitness benefits Coming soon In-network: $0 copay
Health education In-network: $0 copay In-network: $0 copay
Counseling services Not covered Not covered
Over-the-counter drug benefits In-network: $0 copay In-network: $0 copay
Health transportation (non-emergency) Coming soon Not covered

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $250 copay In-network: $250 copay
Lab services In-network: $0-$35 copay
Out-of-network: $0-$35 copay		 In-network: $0-$35 copay
Out-of-network: $0-$35 copay
Outpatient x-rays In-network: $100 copay In-network: $100 copay
Diagnostic tests and procedures In-network: $100 copay In-network: $100 copay

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $140 copay $140 copay
Worldwide emergency care Coming soon $140 copay
Urgent care $60 copay $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		 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		 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 In-network: $200 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $35 copay In-network: $35 copay
Outpatient group therapy In-network: $35 copay 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		 In-network:
Tier 1
$275 per day for days 1-6
$0 per day for days 7-90
$0 per stay

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $35 copay In-network: $35 copay
Occupational therapy In-network: $35 copay In-network: $35 copay

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance
Durable medical equipment In-network: 20% coinsurance In-network: 20% coinsurance
Prosthetics In-network: 20% coinsurance In-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered) In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 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		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Cleaning In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Periodontics In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Endodontics In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Restorative services In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Implant services In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Orthodontics In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Oral/Maxillofacial surgery In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Contact lenses In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Eyeglass frames only Not covered Not covered
Eyeglass lenses only Not covered Not covered
Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Upgrades Not covered Not covered

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay In-network: $0 copay
Fitting/evaluation In-network: $0 copay In-network: $0 copay
Prescription hearing aids In-network: $499-$999 copay In-network: $499-$999 copay
OTC hearing aids Not covered Not covered

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Not covered
Home-based palliative care Not covered Not covered
Personal emergency response system Coming soon Not covered
Weight management programs Not covered Not covered
Wigs for chemotherapy-related hair loss Coming soon Not covered
Alternative therapies Not covered Not covered
Massage therapy Not covered Not covered
Home/bathroom safety devices Not covered 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 ☆☆☆☆☆

Frequently Asked Questions

Here are some of the most frequently asked questions about this plan (click to open).

Frequently Asked Questions About PrimeTime Health Plan Basic - MA Only (HMO-POS)

What is the monthly premium for PrimeTime Health Plan Basic - MA Only (HMO-POS)?

The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.

What is the in-network MOOP for plan H3664-014?

The annual in-network MOOP is $3900.00 for 2027. After this limit is reached, covered in-network services are fully paid.

How many beneficiaries are enrolled in this plan?

CMS reports 371 beneficiaries enrolled in this plan.

What is the Part D deductible for plan H3664-014?

The Part D deductible is $0.00.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
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.

Official plan information and secondary Medicare references.
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

MedicarePlans.com operates as an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.

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