Aspire Health Advantage (HMO)
Aspire Health · HMO · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $196
- Higher than most plans here
- Most you pay in a year for covered care in network
- $4,300
- Higher than most plans here
- Drug deductible
- $0
- Medicare star rating
- 3 of 5
In plain English
Compared with the 5 other plans in Monterey County that the same person could join.
What stands out
- No drug deductible
Watch out for
- $196 monthly premium, higher than most plans here
- Up to $4,300 a year for covered care, higher than most plans here
- $1,800 for a 5-day hospital stay, highest of 6 plans here
- $25 for specialist visits, higher than most plans here
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$2,372$2,352 in premiums + $20 for careHigher than most plans here2 checkups and 2 lab tests.
- A busier year$2,502$2,352 in premiums + $150 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$5,252$2,352 in premiums + $2,900 for careHigher than most plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Uses the highest listed cost for: MRI, CT and other scans.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit$25Higher than most plans herePlan approval may be needed
- Urgent care$0
- Emergency room$115Not charged if you stay in the hospital within 24 hours
- Hospital stay$600 a day for days 1 to 2, then $300 a day for days 3 to 4, then $0 for days 5 to 90Highest of 6 plans herePlan approval may be needed
- Lab tests$10Higher than most plans herePlan approval may be needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$60 to $275Depends on the servicePlan approval may be needed
- Outpatient hospital care$60 to $275 or 20%Depends on the service
- X-rays$10Higher than most plans herePlan approval may be needed
- MRI, CT and other scans$60 to $150Depends on the servicePlan approval may be needed
- Ground ambulance$325Plan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $100 a day for days 21 to 100Plan approval may be needed
From the costs the plan filed with Medicare for 2026. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 5 other plans in Monterey County that the same person could join. Read the plan’s 2026 booklet (PDF)
What medicines cost
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $4 |
| 2Generic | $15 |
| 3Preferred Brand | $47 |
| 4Non-Preferred Drug | 25% of the price |
| 5Specialty Tier | 33% of the price |
| 6Select Care Drugs | $11 |
For a 1-month supply. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2026, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams: $0.
- Vision Not included
- Hearing Not included
- Over-the-counter items Not included
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Included12 one-way rides to medical visits a year.
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take Aspire Health Advantage (HMO), plan number H8764-001, for 2026?”