Longevity Health Plan (HMO I-SNP)
H0363-001 • 2026 • Fremont County, CO
Longevity Health Plan (HMO I-SNP) H0363-001 • 2026 • Fremont County, CO
Longevity Health Plan is a Medicare Institutional plan offered by Longevity Health Plan for the 2026 plan year. It is identified by CMS Plan ID H0363-001 and serves individuals who meet defined eligibility criteria.
Longevity Health Plan Overview
Plan Overview for H0363-001-0 | |
|---|---|
| CMS Plan ID: | H0363-001-0 |
| Plan Type: | HMO I-SNP |
| Plan Year: | 2026 |
| Monthly Premium: | $35.20 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $9250.00 (In-Network) |
| Part B Give Back: | −$1.50 reduction |
| Prescription Drug Coverage: | Basic, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Fremont County, CO |
| Enrollment (Nationwide) | 376 beneficiaries |
| Enrollment (CMS – Local) | 0 beneficiaries in Fremont County |
| Provided By: | Longevity Health Plan |
Plan Overview and Eligibility
- Longevity Health Plan is an Institutional Special Needs Plan (I-SNP) for individuals living in an institution or requiring nursing-level care at home.
- This plan is for individuals living in a long-term care facility.
- Eligibility requires Medicare Part A and Part B and residence within the plan’s service area.
- The plan operates on a {network_type} network, which determines how you access covered services.
- Medicare Part D prescription drug coverage is included. The annual Part D deductible is $615.00.
- Care and cost-sharing may be coordinated based on your care environment.
- Extra Help may provide additional assistance with prescription drug costs.
Longevity Health Plan uses a Health Maintenance Organization (HMO) network for delivery of care. As an HMO member, you generally receive services through the plan’s network of providers, with referrals typically required to see specialists. Emergency care and out-of-area dialysis are covered even outside the network.
Covered Services and Cost Structure
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay |
| Specialist: | In-network: 0%-20% coinsurance |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | Not covered |
| Telehealth benefit: | In-network: 20% coinsurance |
| Routine chiropractic: | Not covered |
| Fitness benefits: | Not covered |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 copay |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: 20% coinsurance |
| Lab services: | In-network: $0 copay |
| Outpatient x-rays: | In-network: 20% coinsurance |
| Diagnostic tests and procedures: | In-network: 20% coinsurance |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $115 copay |
| Worldwide emergency care: | Not covered |
| Urgent care: | 20% coinsurance |
| Inpatient hospital care: | Tier 1 | $0 per day for days 1-60 | $419 per day for days 61-90 | $838 per day for days 91-150 |
| Skilled Nursing Facility: | Tier 1 | Tier 2 | $0 copay |
| Ground ambulance: | In-network: 20% coinsurance |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: 20% coinsurance |
| Outpatient group therapy: | In-network: 20% coinsurance |
| Inpatient psychiatric hospital care: | Tier 1 | $0 per day for days 1-60 | $419 per day for days 61-90 | $838 per day for days 91-150 |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $0 copay |
| Occupational therapy: | In-network: $0 copay |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: 20% coinsurance |
| Durable medical equipment: | In-network: 20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | Not covered |
| Dental x-rays: | Not covered |
| Cleaning: | Not covered |
| Periodontics: | Not covered |
| Endodontics: | Not covered |
| Restorative services: | Not covered |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | Not covered |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| 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): | In-network: $0 copay |
| Upgrades: | In-network: $0 copay |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay |
| Fitting/evaluation: | In-network: $0 copay |
| Prescription hearing aids: | In-network: $0 copay |
| OTC hearing aids: | In-network: $0 copay |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $35.20 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $35.20 |
| Low Income Premium Subsidy: | $35.24 |
| Low Income Premium Subsidy CMS Pays: | $35.20 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Drug Plan Deductible
The prescription drug annual deductible with this plan is $615.00. This is the amount you must pay at the pharmacy before Longevity Health Plan begins paying its share.
Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and drug plan deductible, Longevity Health Plan has costs that you must pay out-of-pocket when you pick up your prescriptions. The following table details those costs by formulary tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | Coming soon |
| Generic drugs | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS Star Ratings
CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.
CMS Star Ratings for Plan H0363-001-0 – 2026
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
| Managing Chronic (Long Term) Conditions | Not enough data available |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | Not enough data available |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Not enough data available |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Longevity Health Plan
| Contact Type | Details |
|---|---|
| Website: | Longevity Health Plan Plan Page |
| New Members: | 1-888-332-5910 |
| Existing Members: | 1-888-332-5938 |
| Plan Address: | 11780 U.S. Highway 1 Suite N107 | Palm Beach Gardens, FL 33408 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation.
- Longevity Health Plan (official source), http://www.longevityhealthplan.com — Last accessed April 30, 2026
- CMS.gov, "Institutional Special Needs Plans (I-SNPs)" — Last accessed April 28, 2026
- CMS.gov, "Medicare Advantage Plan Fact Sheet" — Last accessed April 28, 2026
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed April 28, 2026
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Provenance documentation for this data is maintained under 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.