Tribute Select (HMO-POS I-SNP) Medicare Special Need Plan H1587-003 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- −$199.00 reduction
- Prescription Coverage
- Basic, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 2,624 beneficiaries
Introduction
CMS Plan ID H1587-003 identifies Tribute Select, a Medicare Advantage Institutional Special Needs Plan (I-SNP) offered by Tribute Health Plans. Its provider network is a Health Maintenance Organization with a Point of Service (HMO-POS), and Medicare Part D prescription drug coverage is included. For 2027, the plan has a $0.00 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $700.00.
Enrollment across the plan's service areas totals 2,624 beneficiaries, according to CMS. Enrollment is limited to beneficiaries who live within the plan's service area: See List.
Eligibility
Tribute Select is a Hybrid Institutional (HI-SNP) plan for individuals that require nursing care.
- 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.
Plan Benefits
Tribute Select 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 H1587-003.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance |
| Specialist | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay | In-network: $0 copay |
| Telehealth benefit | In-network: 20% coinsurance | In-network: 20% coinsurance |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | Not covered |
| Health education | Not covered | In-network: $0 copay |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay | Not covered |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Lab services | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
| Outpatient x-rays | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Diagnostic tests and procedures | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | 20% coinsurance | 20% coinsurance |
| Worldwide emergency care | Coming soon | Not covered |
| Urgent care | 20% coinsurance | 20% coinsurance |
| Inpatient hospital care | In-network: Tier 1 $0 per day for days 1-60 $434 per day for days 61-90 $868 per day for days 91-150 Out-of-network: $0 per day for days 1-60 $434 per day for days 61-90 $868 per day for days 91-150 |
In-network: Tier 1 $0 per day for days 1-60 $419 per day for days 61-90 $838 per day for days 91-150 Out-of-network: $0 per day for days 1-60 $419 per day for days 61-90 $838 per day for days 91-150 |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $217 per day for days 21-100 |
In-network: Tier 1 $0 per day for days 1-20 $209.5 per day for days 21-100 |
| Ground ambulance | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
| Outpatient group therapy | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
| Inpatient psychiatric hospital care | In-network: Tier 1 $0 per day for days 1-60 $434 per day for days 61-90 $868 per day for days 91-150 Out-of-network: $0 per day for days 1-60 $434 per day for days 61-90 $868 per day for days 91-150 |
In-network: Tier 1 $0 per day for days 1-60 $419 per day for days 61-90 $838 per day for days 91-150 Out-of-network: $0 per day for days 1-60 $419 per day for days 61-90 $838 per day for days 91-150 |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
| Occupational therapy | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | Not covered | Not covered |
| Dental x-rays | Not covered | Not covered |
| Cleaning | Not covered | Not covered |
| Periodontics | Not covered | Not covered |
| Endodontics | Not covered | Not covered |
| Restorative services | Not covered | Not covered |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | Not covered | Not covered |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | Not covered | Not covered |
| Contact lenses | Not covered | Not covered |
| Eyeglass frames only | Not covered | Not covered |
| Eyeglass lenses only | Not covered | Not covered |
| Eyeglasses (frames & lenses) | Not covered | Not covered |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | Not covered | Not covered |
| Fitting/evaluation | Not covered | Not covered |
| Prescription hearing aids | Not covered | Not covered |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| 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 Tribute Select as a Part B benefit.
Prescription Drug Coverage
Tribute Select 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: | $6.28 |
| 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 $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Tribute Health Plans starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Tribute Select may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | 25% coinsurance |
| Generic drugs | 25% coinsurance | 25% coinsurance |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H1587)
Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Tribute Health Plans
- Website
- Tribute Health Plans Plan Page
- Providers
- Tribute Health Plans Providers Page
- Formulary
- Tribute Health Plans Formulary Page
- Pharmacy
- Tribute Health Plans Pharmacy Page
- New Member Health Plan Help
- (877)372-1033
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (877)372-1033
- 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.
Plan Availability
Tribute Select (H1587-003-0) is available in the following locations (click to open):
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 |
|---|---|---|
| Tribute Health Plans (official source) | http://www.tributemedicare.com | October 4, 2026 |
| CMS.gov | Institutional Special Needs Plans (I-SNPs) | April 28, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | April 28, 2026 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | April 28, 2026 |
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