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Perennial Advantage Premier (HMO-POS I-SNP) Medicare Special Need Plan H8797-004 • 2027

CMS Rating: Not yet rated by CMS.
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
See List
Total Enrollment
0 beneficiaries
Last update:

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 has 0 beneficiaries enrolled across its service areas based on CMS enrollment data. To enroll, you must live within the plan's service area: See List.

Eligibility

Perennial Advantage Premier is an Hybrid Institutional (HI-SNP) plan for individuals requiring nursing-level 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

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.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Specialist In-network: $0-$5 copay
Out-of-network: $5 copay		 In-network: $10 copay
Out-of-network: $10 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-$35 copay In-network: $0-$35 copay
Routine chiropractic In-network: $20 copay In-network: $20 copay
Fitness benefits Coming soon In-network: $0 copay
Health education Not covered Not covered
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: $75 copay In-network: $125 copay
Lab services In-network: $0 copay In-network: $0 copay
Outpatient x-rays In-network: $0 copay In-network: $0 copay
Diagnostic tests and procedures In-network: $40 copay In-network: $60 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 $90 copay $90 copay
Worldwide emergency care Coming soon Not covered
Urgent care 20% coinsurance 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		 In-network:
Tier 1
$275 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:		 In-network:
Tier 1
$0 per day for days 1-20
$209.5 per day for days 21-100
Tier 2
$0 copay
Out-of-network:
$0 per day for days 1-20
$209.5 per day for days 21-100
Ground ambulance In-network: $250 copay In-network: $250 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: 20% coinsurance In-network: 20% coinsurance
Outpatient group therapy In-network: 20% coinsurance 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		 In-network:
Tier 1
$275 per day for days 1-5
$0 per day for days 6-90
$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: $0-$25 copay In-network: $0-$25 copay
Occupational therapy In-network: $0-$25 copay In-network: $0-$25 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 copay In-network: 0% 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 In-network: $0 copay
Dental x-rays In-network: $0 copay In-network: $0 copay
Cleaning In-network: $0 copay In-network: $0 copay
Periodontics In-network: $0 copay In-network: $0 copay
Endodontics In-network: $0 copay In-network: $0 copay
Restorative services In-network: $0 copay In-network: $0 copay
Implant services In-network: $0 copay In-network: $0 copay
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery In-network: $0 copay In-network: $0 copay

Vision Services

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

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: $0 copay In-network: $0 copay
OTC hearing aids In-network: $0 copay In-network: $0 copay

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 In-network: $0 copay In-network: $0 copay
Home/bathroom safety devices Not covered 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.

Perennial Advantage Premier (H8797-004-0) Prescription Drug Plan Premium Details
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.

Perennial Advantage Premier (H8797-004-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copay$0.00 copay
Generic$10.00 copay$10.00 copay
Preferred Brand25% coinsurance$45.00 copay
Non-Preferred Drug25% coinsurance$95.00 copay
Specialty Tier33% coinsurance33% 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.

2027 Medicare Star Ratings for Contract H8797
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
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
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.