Banner Medicare Advantage Plans 2025

Looking for the latest on Medicare Advantage plans 2025? This article delivers essential updates on plan offerings, including comprehensive coverage details, prescription drug benefits, and cost considerations—all to aid your decision-making process for optimal Medicare coverage in the upcoming year.


Key Takeaways

  • Banner Medicare Advantage Plans for 2025 offer comprehensive health coverage that includes medical, prescription drug, dental, vision, and lifestyle benefits such as meal programs and fitness memberships.


  • The Banner Medicare Advantage Prime (HMO) H5843-001-0 plan provides zero percent coinsurance for Medicare-covered diabetic supplies, $0 deductibles for medications, and additional services like dental, vision, hearing as well as wellness programs, with an out-of-pocket limit of $2,775 for in-network services.


  • Banner Medicare Advantage plans boast extensive provider networks, enabling access to a broad range of healthcare services, including preventive and specialized care, and are rated between 3 to 4.5 stars by CMS, signifying their quality and performance.

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Understanding Banner Medicare Advantage Plans for 2025

The Banner Medicare Advantage Plans for 2025 distinguish themselves in the market with their extensive coverage. Their approach to health insurance for eligible beneficiaries is holistic, covering:


  • Medicare health care
  • Prescription drugs
  • Dental
  • Vision
  • Meal programs
  • Fitness memberships


Furthermore, the year 2025 will bring modifications and enhancements to these plans, maintaining their relevance and competitive edge in coverage alternatives.


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These plans, known as doctors healthcare plans, provide coverage for a plethora of essential drug and health services, along with bonus benefits such as dental and vision insurance. In addition, they offer lifestyle perks like in-home meal deliveries and fitness center memberships, making them a competitive choice even in areas with high healthcare standards.

It’s worth noting that these plans act as primary insurance, substituting traditional Medicare. They offer comprehensive coverage for Medicare Part A and Part B, along with potential additional benefits, through collaboration with Medicare.


Exploring the Benefits of Banner Medicare Advantage Prime (HMO) H5843-001-0

One of Banner’s top offerings, provided by Ultimate Healthcare Holdings, is the Banner Medicare Advantage Prime (HMO) H5843-001-0, a Cross Blue Shield affiliated health plan.

This 2025 HMO Medicare Advantage plan offers a holistic health plan that encompasses comprehensive healthcare and Part D prescription drug coverage, along with 0% coinsurance for Medicare-covered diabetic supplies.


Coverage Details and Out-of-Pocket Expenses

The Banner Medicare Advantage Prime (HMO) H5843-001-0 plan offers a broad range of healthcare services, with a particular emphasis on:


  • Preventive and primary care
  • 0% coinsurance for Medicare-covered diabetic supplies
  • Coverage for prescription drugs, featuring a specified formulary
  • Preferred cost-sharing options at select pharmacies during the initial coverage phase


While enrollees can expect to face some out-of-pocket expenses such as a $25 copayment for each primary care visit and copayments for 30-day and 90-day supplies of medications, the plan does offer some relief with a maximum annual out-of-pocket limit of $2,775 for in-network services.


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Moreover, the prescription drug plan within the Banner Medicare Advantage Prime (HMO) H5843-001-0 entails an annual deductible of $0.00, indicating that members are not required to pay a deductible for covered medications.


Prescription Drug Plan Perks

When it comes to prescription drugs, the Banner Medicare Advantage Prime (HMO) H5843-001-0 plan stands out with its unique attributes. The plan offers specific copays and coinsurance rates for the following drug tiers:


  • Tier 1: copay of $10.00
  • Tier 2: copay of $47.00
  • Preferred brand drugs: copay of $47.00
  • Non-preferred brand drugs: copay of $100.00
  • Specialty tier drugs: copay of 33%
  • Generics and brand-name drugs not on the preferential list: coinsurance rate of 25%


The plan provides coverage for 377 drugs in Tier 1 and 1106 drugs in Tier 2. Preferred pharmacy cost-sharing during the initial coverage phase is $0.00 for Tier 1 drugs and $5.00 for Tier 2 drugs. Moreover, during the coverage gap phase, Tier 1 drugs are available with a $0 copay.


Extra Services and Programs

The Banner Medicare Advantage Prime plan offers:


  • Healthcare and prescription drug coverage
  • Dental services
  • Vision services
  • Hearing services
  • Wellness programs such as the Healthy Living programs and the Silver&Fit® Healthy Aging and Exercise program


Vision and dental services are also available to members as part of their comprehensive Scan Health Plan benefits.

Furthermore, the plan provides members with additional services such as nutrition-focused meal deliveries, transportation for scheduled medical visits, and diagnostic radiology services, adding convenience and value to the overall package.

Comparing Costs Across Banner’s Medicare Advantage Offerings

When assessing the costs of various Banner Medicare Advantage plans, it’s important to factor in:


  • Diverse benefits
  • Provider networks
  • The influence of elements such as copays, drug coverage, additional benefits, health status, health care utilization, and supplemental insurance.


Premiums and Deductibles Across Plans

Banner Medicare Advantage plan premiums are determined based on various factors, leading to varying amounts, with some plans having a $0 premium and others requiring a monthly fee. Deductibles differ across these plans, ranging from $0 to up to $480, indicating variability based on plan selection.


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Various factors influence the premiums and deductibles in Banner Medicare Advantage plans, including:


  • Healthcare costs
  • Provider network arrangements
  • The health status and care usage of the enrollee
  • The level of supplemental coverage chosen.


Understanding Cost-Sharing Features

The cost-sharing features within Banner Medicare Advantage plans may encompass:


  • Waived cost-sharing for Part D drugs for those eligible for a low-income subsidy
  • Various tiers with copayments for prescription drugs
  • Specific cost-sharing amounts for different services and medications.


Banner Medicare Advantage plans provide:

  • The option of $0 or low monthly premiums
  • $0 deductibles
  • $0 copayments for specific services
  • The coinsurance rate for Banner Medicare Advantage plans for other Part B drugs is 20%.


Medicare mandates that all health plans must cap the annual out-of-pocket expenses for beneficiaries. This cap, known as the maximum out-of-pocket amount, serves to safeguard individuals from excessive medical expenditures.


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The Network Advantage: Providers and Facilities

Banner Medicare Advantage Plans offer the following benefits:


  • Extensive network of providers, including primary care providers and specialists
  • Collaboration with Medicare and a variety of commercial and Medicare Advantage plans
  • Access to a broad spectrum of healthcare services comparable to traditional Medicare Parts A, B, and Part D Prescription Drug coverage


Access to Specialists and Primary Care

The Banner Medicare Advantage plan provides:


  • A comprehensive network of healthcare providers
  • Access to a wide range of primary care physicians within the network
  • A broad range of medical specialists
  • Flexibility to select from this diverse network without requiring referrals.


Locating an in-network physician or specialist can be easily accomplished by utilizing the online directories available on the Banner Health website.


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These tools enable plan members to efficiently search for and choose the suitable in-network providers for their healthcare requirements.


Hospital and Skilled Nursing Facility Affiliations

Banner Medicare Advantage plans offer the following benefits:


  • Extensive network of doctors, hospitals, and pharmacies
  • Ability to easily locate in-network hospitals nearby through their directories
  • Improved patient care, providing lower costs and reducing hospitalization rates for individuals enrolled in Banner Medicare Advantage plans.


Affiliated skilled nursing facilities can be identified by consulting the Banner Medicare Advantage Plus PPO Plan Provider Directory and the Banner Medicare Advantage Dual’s current network providers list.

Affiliations with skilled nursing facilities in Medicare Advantage plans provide coverage for a variety of services including in-home care, stays in skilled nursing facilities, hospice care, and certain home care services.

Star Ratings and Quality Measures

The star ratings for Banner Medicare Advantage plans in 2025 range from 4.5 stars to 3 stars. Some plans received the following ratings:


  • 4.5 stars
  • 4 stars
  • 3.5 stars
  • 3 stars


These ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and serve as a tool for comparing the quality of Medicare Advantage plans.

Banner Medicare Advantage plans employ standardized quality improvement outcome and process measures. The star ratings for Banner Medicare Advantage plans for 2025 range from 4.5 stars to 3 stars.

While the answer does not explicitly provide a direct comparison to the national average, it indicates a performance variation relative to industry benchmarks.


Enrollment Periods and Eligibility Criteria

In order to enroll in a Banner Medicare Advantage plan, individuals must meet the following criteria:


  • Be entitled to Medicare Part A
  • Be enrolled in Medicare Part B
  • Reside in the plan’s service area. Residency is defined as living at the permanent address for at least half of the year.


The enrollment period for Banner Medicare Advantage plans for 2025 is from October 15th to December 7th, known as the Annual Election Period.

If you are not in the plan service area of Banner Medicare Advantage, or you meet other specific conditions, your current plan will initiate a Special Enrollment Period for you to select a new plan.

Enrolling late in a Banner Medicare Advantage plan without having other creditable drug coverage may result in a lifetime Part D late enrollment penalty, which is 1% of the average Part D premium for each month you delay enrollment.


Comparing Banner to Other Medicare Advantage Providers

A comparison of Banner’s Medicare Advantage plans with Aetna’s offerings reveals that both companies prioritize delivering comprehensive and personalized care.

Similarly, Anthem’s Medicare Advantage plan provides essential doctor, hospital, and prescription drug coverage, much like Banner’s variety of HMO, PPO, and HMO D-SNP Medicare Advantage plans.

Cigna’s Medicare Advantage plans feature:


  • $0 premium advantage
  • $0 copays for primary care visits
  • $15 copays for specialists
  • $2,700 out-of-pocket maximum


On the other hand, Banner also provides Blue Cross Medicare Advantage plans with $0 cost benefits, striving to offer more coverage than Original Medicare.


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Both Banner and Humana Medicare Advantage plans, as well as Molina Healthcare, provide prescription drug coverage, with Banner’s plans being specifically tailored to provide comprehensive healthcare, incorporating medical and prescription drug benefits in a single plan based in Arizona.


Maximizing Your Benefits with Banner Medicare Advantage

Banner Medicare Advantage plans offer the following benefits:


  • Coverage of a wide array of preventive services, including any additional services approved by Medicare during the contract year
  • $0 copayment for each preventive service
  • Opportunity to participate in wellness programs such as the Healthy Living programs and the Silver&Fit® Healthy Aging and Exercise program


These benefits are designed to support devoted health, enabling healthy living for an active, independent lifestyle. With the assistance of Independence Health Group, individuals can maintain their well-being and continue enjoying life to the fullest in York City Health.

It is advisable to acquaint oneself with the drug list and the coverage details to effectively maximize the benefits associated with medication.

The out-of-pocket maximum limit in Banner Medicare Advantage plans serves as a safeguard against excessive medical expenses. It is mandated by Medicare for all health plans. Enrollees can optimize the utilization of this limit by gaining clarity on the healthcare services and expenses included in the out-of-pocket maximum, and by prioritizing in-network providers and services whenever feasible.


Navigating Additional Supplemental Benefits

Banner Medicare Advantage plans offer a range of comprehensive benefits that go further than Original Medicare. These encompass prescription drug coverage, access to high-quality care, and additional services tailored to ensure comprehensive health care coverage.


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To effectively utilize these optional supplemental benefits, consider selecting an enhanced benefit Medicare Part D plan for more comprehensive coverage.

Supplemental benefits can be added to your Banner Medicare Advantage plan by considering the available options, such as the HMO, PPO, and HMO D-SNP plans, to find the ones that best fit your requirements. The expenses for adding supplementary benefits can differ depending on the particular benefits and plan chosen.

Certain benefits, such as preventive dental services, may be accessible at no additional cost through universal health services, with a $0 copay.


In conclusion, Banner Medicare Advantage Plans for 2025 offer comprehensive coverage, a wide network of providers, and additional benefits such as preventive services, wellness programs, and prescription drug coverage.

Enrollees can maximize their benefits by understanding their coverage details, participating in wellness programs, and using in-network providers.

The plan’s star ratings and quality measures reflect its commitment to providing high-quality services. With a range of plans to choose from, Banner Medicare Advantage is a viable option for those seeking comprehensive healthcare coverage.

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Frequently Asked Questions


What is the rate increase for Medicare Advantage in 2025?

The average monthly premium for Medicare Advantage plans is expected to increase from $17.86 in 2023 to $18.50 in 2025, but almost 73 percent of enrollees will not experience any premium increase if they stay on their plan.


Is Medicare premiums going down in 2025?

Medicare premiums are going up in 2025. The standard monthly premium for Part B will increase to $174.70, with higher incomes requiring higher payments due to income-related adjustments. Nov 6, 2023.


What is the initial coverage limit for 2025?

The initial coverage limit for 2025 is $5,030. This limit is set by Medicare and ends when the amount spent by you and your plan on covered drugs reaches this amount.


Why are people leaving Medicare Advantage plans?

Many people are leaving Medicare Advantage plans due to excessive prior authorization denial rates and slow payments from insurers. These issues have made it difficult for individuals to access timely and affordable healthcare.


Can I access preventive services with Banner Medicare Advantage Plans?

Absolutely, Banner Medicare Advantage plans cover a variety of preventive services with no copayment. You can easily access these services without any additional cost.

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Compare Medicare Plans

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