Medicare Plans

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Premier Care (HMO-POS I-SNP) H2185-003 • 2027 • Carroll County, VA

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$4000.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $75.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
Carroll County, VA
Local Enrollment
0 beneficiaries in Carroll County
Last update:

Introduction

CMS Plan ID H2185-003 identifies Premier Care, a Medicare Advantage Institutional Special Needs Plan (I-SNP) offered by Lifeworks Advantage. 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 $4000.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $75.00.

Enrollment in this plan requires you to live in Carroll County, Virginia. CMS reports 0 beneficiaries enrolled in this plan in Carroll County. New members can call the plan directly at (844)854-6883 (TTY 711) for assistance.

Eligibility

Premier Care is a Hybrid Institutional (HI-SNP) plan designed for individuals who need 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.

Compare Similar Plans in Carroll County

Although no other HMO-POS I-SNP plans meet the comparison criteria in Carroll County, you may have other Medicare Advantage options. Browse all Medicare Advantage SNP plans available in Carroll County, or explore our Virginia Medicare Special Needs directory for statewide information on plan availability, premiums, out-of-pocket costs, CMS ratings, and enrollment.

Plan Benefits

Premier Care 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 H2185-003.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H2185-003-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Specialist
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance

Preventive and Wellness Services

Annual wellness exam
Not covered
Telehealth benefit
In-network: $0 copay
Routine chiropractic
In-network: $30 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: 20% coinsurance
Out-of-network: 20% coinsurance
Lab services
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Outpatient x-rays
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Diagnostic tests and procedures
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Emergency and Urgent Care Services

Emergency room care
$75 copay
Worldwide emergency care
Coming soon
Urgent care
$25 copay
Inpatient hospital care
In-network:
Tier 1
$0 per stay
Out-of-network:
$0 per stay
Skilled Nursing Facility
In-network:
$0 copay
Ground ambulance
In-network: 20% coinsurance

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
$0 per stay
Out-of-network:
$0 per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $0 copay
Occupational therapy
In-network: $0 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
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

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
Not covered
Home/bathroom safety devices
Not covered

Certain preventive services are covered 100% by Premier Care as a Part B benefit.

Prescription Drug Coverage

Premier Care 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.

Premier Care (H2185-003-0) 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:$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 $75.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Lifeworks Advantage starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Premier Care may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Premier Care (H2185-003-0) 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 Brand$45.00 copay$45.00 copay
Non-Preferred Drug$95.00 copay$95.00 copay
Specialty Tier32% coinsurance25% coinsurance
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H2185)

Medicare evaluates plan quality using a star rating system developed by the Centers for Medicare & Medicaid Services (CMS). Ratings are based on measures such as health outcomes, member experience, and customer service, and are reported on a 1 to 5 star scale, with higher ratings indicating stronger overall performance.

2027 Medicare Star Ratings for Contract H2185
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 Lifeworks Advantage

Website
Lifeworks Advantage Plan Page
Providers
Lifeworks Advantage Providers Page
Formulary
Lifeworks Advantage Formulary Page
Pharmacy
Lifeworks Advantage Pharmacy Page
New Member Health Plan Help
(844)854-6883
New Member Health Plan TTY
711
New Member Part D Help
(844)854-6883
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
Lifeworks Advantage (official source) http://www.alignseniorcare.com October 4, 2026
CMS.gov Institutional Special Needs Plans (I-SNPs) April 28, 2026
Medicare.gov Understanding Medicare Advantage Plans April 28, 2026
AARP.org The Big Choice: Original Medicare vs. Medicare Advantage April 28, 2026

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 documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.