Perennial Advantage Premier (HMO-POS I-SNP) H8797-004 • 2027 • Shelby County, OH
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4600.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $0.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Shelby County, OH
- Local Enrollment
- 0 beneficiaries in Shelby County
Introduction
Perennial Advantage Premier, offered by Perennial Advantage, is a Medicare Advantage Institutional Special Needs Plan (I-SNP) identified by CMS Plan ID H8797-004. The plan's Health Maintenance Organization with a Point of Service (HMO-POS) provider network serves its covered medical benefits, and the plan includes Medicare Part D prescription drug coverage. Its 2027 costs include a $0.00 monthly premium, $0.00 medical deductible, and $4600.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $0.00.
This plan is available to eligible beneficiaries who live in Shelby County, Ohio. According to CMS, 0 beneficiaries in Shelby County are enrolled in this plan. New members can contact the plan at (844)788-6986 (TTY 711) for help and additional plan information.
Eligibility
- Special Needs Plan Type
- Institutional Special Needs Plan (I-SNP)
- Medicare Requirement
- Must have Medicare Part A and Part B
- Special Needs Requirement
- This plan accommodates individuals in a long-term care facility. It is also available to people who need the level of care given in a long-term care facility who can remain at home or live in an assisted living facility.
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Compare Similar Plans in Shelby County
Although no other HMO-POS I-SNP plans meet the comparison criteria in Shelby County, you may have other Medicare Advantage options. Browse all Medicare Advantage SNP plans available in Shelby County, or explore our Ohio Medicare Special Needs directory for statewide information on plan availability, premiums, out-of-pocket costs, CMS ratings, and enrollment.
Plan Benefits
Perennial Advantage Premier has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H8797-004.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H8797-004-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Specialist
- In-network: $0-$5 copay
Out-of-network: $5 copay
Preventive and Wellness Services
- Annual wellness exam
- Not covered
- Telehealth benefit
- In-network: $0-$35 copay
- Routine chiropractic
- In-network: $20 copay
- Fitness benefits
- Coming soon
- Health education
- Not covered
- 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: $75 copay
- Lab services
- In-network: $0 copay
- Outpatient x-rays
- In-network: $0 copay
- Diagnostic tests and procedures
- In-network: $40 copay
Emergency and Urgent Care Services
- Emergency room care
- $90 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- 20% coinsurance
- Inpatient hospital care
- In-network:
Tier 1
$150 per day for days 1-5
$0 per day for days 6-90
$0 per stay - Skilled Nursing Facility
- In-network:
$0 copay
Out-of-network: - Ground ambulance
- In-network: $250 copay
Mental Health Services
- Outpatient individual therapy
- In-network: 20% coinsurance
- Outpatient group therapy
- In-network: 20% coinsurance
- Inpatient psychiatric hospital care
- In-network:
Tier 1
$150 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $0-$25 copay
- Occupational therapy
- In-network: $0-$25 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- 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
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- In-network: $0 copay
- Endodontics
- In-network: $0 copay
- Restorative services
- In-network: $0 copay
- Implant services
- In-network: $0 copay
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: $0 copay
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- Not covered
- 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
Hearing Services
- 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
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
- In-network: $0 copay
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by Perennial Advantage Premier as a Part B benefit.
Prescription Drug Coverage
Perennial Advantage Premier includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $21.05 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Perennial Advantage starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Perennial Advantage Premier may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | $0.00 copay |
| Generic | $10.00 copay | $10.00 copay |
| Preferred Brand | 25% coinsurance | $45.00 copay |
| Non-Preferred Drug | 25% coinsurance | $95.00 copay |
| Specialty Tier | 33% coinsurance | 33% coinsurance |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H8797)
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 Measure | Star Rating |
|---|---|
| 2027 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 Perennial Advantage
- Website
- Perennial Advantage Plan Page
- Providers
- Perennial Advantage Providers Page
- Formulary
- Perennial Advantage Formulary Page
- Pharmacy
- Perennial Advantage Pharmacy Page
- New Member Health Plan Help
- (844)788-6986
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (844)788-6986
- New Member Part D TTY Users
- 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 |
|---|---|---|
| Perennial Advantage (official source) | http://www.perennialadvantage.com | October 4, 2026 |
| CMS.gov | Institutional Special Needs Plans (I-SNPs) | April 28, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | April 28, 2026 |
| Medicare.gov | Joining a plan | April 28, 2026 |
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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.