- Entity
- plan:H3664-014-0
- Digest
- 2026-cms-snp-plan
- Source URL
- https://www.medicareplans.com/medicare-advantage/plan/H3664-014-0/
- Glossary Scope
- cms_landscape
- Fragment Scope
- semantic-digest
- Method
- https://webmem.com/protocol/serialization/html/
- fragment-H3664-014-0-performance
- CMS Plan ID
- All MA/MAPD and PDP plans have a CMS plan ID consisting of a contract ID, plan ID, and segment ID formatted like: H1234-001-0.
- Value
- H3664-014-0
- Derived
- true
- Contract Year
- The calendar year in which the plan's benefits, premiums, and rules are effective as defined by CMS.
- Value
- 2026
- Derived
- false
- Contract Category Type
- The CMS-assigned contract type for the plan, such as MA, MAPD, SNP, or PDP, which indicates the scope of services and population the contract is designed to serve.
- Value
- MA
- Derived
- false
- Contract ID
- The unique contract ID assigned to a carrier by CMS. All plans have a contract ID.
- Value
- H3664
- Derived
- false
- Plan ID
- The unique plan ID within a CMS contract.
- Value
- 014
- Derived
- false
- Segment ID
- A segment ID is used to identify specific geographic market segments or subdivisions for variations in benefits, costs, and premiums.
- Value
- 0
- Derived
- false
- Parent Organization Name
- The legal parent company that owns the Medicare Advantage contract and is ultimately responsible for the plan’s administration.
- Value
- Aultman Health Foundation
- Derived
- false
- Organization Marketing Name
- The publicly marketed name of the Medicare Advantage plan carrier as displayed to consumers, which may differ from the legal or corporate entity name.
- Value
- PrimeTime Health Plan
- Derived
- false
- Organization Type
- A descriptive label that classifies the Medicare plan contract type in plain language, such as Local HMO, Regional PPO, or SNP.
- Value
- Local CCP
- Derived
- true
- Plan Name
- The official name of the Medicare Advantage plan as listed in CMS source data.
- Value
- PrimeTime Health Plan Basic - MA Only (HMO-POS)
- Derived
- false
- Plan Type
- The type of Medicare plan, such as PDP, Regional PPO, HMO-POS, HMO D-SNP, which determines how the plan manages care and provider access.
- Value
- HMO-POS
- Derived
- false
- Special Needs Plan (SNP) Indicator
- Indicates whether the plan is a Special Needs Plan (SNP), designed to serve people with specific diseases, dual eligibility, or institutional needs.
- Value
- No
- Derived
- false
- SNP Type
- Specifies the type of Special Needs Plan, such as D-SNP for dual-eligible individuals, C-SNP for chronic conditions, or I-SNP for institutional care.
- Value
- Not Applicable
- Derived
- false
- Part D Coverage Indicator
- Indicates whether the Medicare Advantage plan includes Part D prescription drug coverage.
- Value
- No
- Derived
- false
- Drug Benefit Category
- Specifies whether the plan’s drug benefit is defined as basic, enhanced, or other CMS-classified categories.
- Value
- Not Applicable
- Derived
- false
- Drug Benefit Type
- Specifies the delivery structure of the plan’s drug benefit, such as defined standard, actuarially equivalent, or enhanced alternative.
- Value
- Not Applicable
- Derived
- false
- Voluntary De Minimis
- Indicates whether the plan participates in the voluntary de minimis policy, allowing small premium differences without disqualifying LIS benchmark eligibility.
- Value
- No
- Derived
- false
- Part D Basic Premium Benchmark
- The CMS-calculated benchmark for basic Part D premiums used to determine Low-Income Subsidy (LIS) eligibility thresholds.
- Value
- Not Applicable
- Derived
- false
- LIS Auto-Enrollment Eligible
- Indicates whether the plan is eligible for automatic enrollment of Low-Income Subsidy (LIS) beneficiaries by CMS.
- Value
- Not Applicable
- Derived
- false
- Drug Tiers with No Deductible
- Indicates which drug tiers are excluded from the plan’s Part D deductible, allowing members to access medications without paying the deductible first.
- Value
- Not Applicable
- Derived
- false
- Part D Deductible
- The annual amount a member must pay out of pocket for Part D drugs before the plan begins to pay.
- Value
- Not Applicable
- Derived
- false
- Part D Basic Premium
- The portion of the plan's monthly premium that covers the standard Part D drug benefit.
- Value
- Not Applicable
- Derived
- false
- Part D Supplemental Premium
- The monthly premium amount for any supplemental drug coverage offered beyond the standard Part D benefit.
- Value
- Not Applicable
- Derived
- false
- Part D Total Premium
- The total monthly premium for the Part D plan, including both the basic and any supplemental components.
- Value
- Not Applicable
- Derived
- true
- Low Income Premium Subsidy (LIPS) Amount
- The amount of monthly premium subsidized by CMS for Low-Income Subsidy (LIS) eligible members enrolled in the plan.
- Value
- 31.38
- Derived
- false
- Part D LIPS (CMS Pays)
- The total amount CMS pays on behalf of LIS-eligible enrollees to cover premium costs under the Low-Income Subsidy program.
- Value
- Not Applicable
- Derived
- false
- Part D Low Income Beneficiary Premium Amount
- The amount that a Low-Income Subsidy (LIS) beneficiary is responsible for paying after CMS premium subsidies have been applied.
- Value
- Not Applicable
- Derived
- true
- Part D Out-of-Pocket (OOP) Threshold
- The total amount a member must spend on covered Part D drugs in a calendar year before entering the catastrophic coverage phase.
- Value
- Not Applicable
- Derived
- false
- Part C Premium
- The monthly premium a member pays for Medicare Advantage (Part C) coverage, excluding prescription drug (Part D) premiums.
- Value
- $0.00
- Derived
- false
- Monthly Consolidated Premium (Part C + D)
- The total monthly premium a member pays for the Medicare Advantage plan, including both Part C and Part D coverage.
- Value
- Not Applicable
- Derived
- true
- In-Network Maximum Out-of-Pocket (MOOP) Amount
- The maximum amount a member will pay out of pocket for in-network Medicare-covered services during the plan year, after which the plan pays 100%.
- Value
- Derived
- false
- Record Checksum
- Checksum value associated with this published plan record.
- Value
- VXQ-731-H3664-014-0
- Derived
- true
- Entity
- contract:H3664
- Digest
- 2026-cms-part-c-and-d-performance
- Source URL
- https://www.medicareplans.com/medicare-advantage/plan/H3664-014-0/
- Glossary Scope
- cms_performance
- Fragment Scope
- semantic-digest
- Method
- https://webmem.com/protocol/serialization/html/
- fragment-H3664-014-0-landscape
- Overall Star Rating
- The overall CMS star rating for the plan, based on quality and performance across all measured domains.
- Value
- 4.5
- Unit
- stars
- Derived
- false
- Staying Healthy Measure
- Includes preventive screenings, vaccines, and wellness checks that help members stay healthy.
- Value
- 4
- Unit
- stars
- Derived
- false
- Managing Chronic Conditions Measure
- Evaluates how effectively the plan helps members manage chronic health conditions like diabetes, COPD, or hypertension.
- Value
- 3
- Unit
- stars
- Derived
- false
- Member Experience Measure (Health Plan)
- Captures what members say about their experience with the health plan.
- Value
- 5
- Unit
- stars
- Derived
- false
- Plan Complaints Measure
- Tracks member complaints and changes in the plan’s performance over time.
- Value
- 5
- Unit
- stars
- Derived
- false
- Health Plan Customer Service Measure
- Measures how well the plan handles member appeals and customer inquiries.
- Value
- 5
- Unit
- stars
- Derived
- false
PrimeTime Health Plan Basic - MA Only (HMO-POS) Medicare Advantage Plan H3664-014 • 2026
PrimeTime Health Plan Basic - MA Only is a Medicare Advantage HMO-POS plan offered by PrimeTime Health Plan for the 2026 plan year. It uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes without prescription drug coverage. CMS Plan ID H3664-014 identifies this plan.
PrimeTime Health Plan Basic - MA Only Overview
Plan Overview for
H3664-014-0
|
|
|---|---|
| CMS Plan ID: |
H3664-014-0
|
| Plan Type: | HMO-POS |
| Plan Year: | 2026 |
| Monthly Premium: |
$0.00
Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $3900.00 (In-Network) |
| Part B Give Back: | −$75.00 reduction |
| Prescription Drug Coverage: | Not Included |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | See List |
| Enrollment (Nationwide): | 372 beneficiaries |
| Provided By: | PrimeTime Health Plan |
Plan Availability
PrimeTime Health Plan Basic - MA Only (H3664-014-0) is available in the following locations (click to open):
Plan Details for PrimeTime Health Plan Basic - MA Only
PrimeTime Health Plan Basic - MA Only is a Medicare Advantage HMO-POS plan that provides Medicare Part A and Part B coverage through a network of participating providers, with limited coverage available for out-of-network services in certain situations. The monthly premium is $0.00, and costs are generally lower when services are received from in-network providers.
Primary care visits have a $0 copay, specialist visits come with a $40 copay, urgent care services carry a $60 copay, and ambulance transportation is $200 copay. These costs apply toward the maximum out-of-pocket (MOOP) limit of $3900.00. Once 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 H3664-014. Cost-sharing details are provided below.
Cost Sharing Expenses
PrimeTime Health Plan Basic - MA Only 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 H3664-014.
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.
Medicare Plan Star Ratings
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 |
|---|---|
| 2026 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 |
How much does plan H3664-014 cost per month?
The plan’s monthly premium is $0.00 for 2026. The Part B premium is not included.
What is the annual out-of-pocket maximum (MOOP) for this plan?
The annual in-network MOOP is $3900.00 for 2026. After this limit is reached, covered in-network services are fully paid.
How many beneficiaries are enrolled in this plan?
CMS reports 372 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2026?
For 2026, the prescription drug deductible is $0.00.
Contact Information for PrimeTime Health Plan
| Contact Type | Details |
|---|---|
| Website: | PrimeTime Health Plan Plan Page |
| New Members: | 1-855-877-1049 |
| Existing Members: | 1-800-577-5084 |
| Plan Address: | Morrow House | 2600 Sixth Street SW | Canton, OH 44710 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | September 8, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| PrimeTime Health Plan (official source) | http://www.primetimehealthplan.com | October 13, 2025 |
| 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 |
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 is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
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.