Benefits and Services
Your Plan, Designed for You
Abilis Health Plan offers all the coverage of Original Medicare, plus enhanced benefits designed for individuals who need long-term or facility-based care.
Abilis Health Plan gives you more than what’s covered by Original Medicare. As a Special Needs Plan (FI-SNP & IE-SNP), Abilis Health includes all the benefits of Medicare Parts A and B—plus prescription drug coverage (Part D) and added support including:
- Preventive wellness care
- Medication management
- Advance care planning
- Chronic condition support
- Patient and family education
Service Areas
Counties We Serve: Adair, Allen, Anderson, Barren, Bath, Bourbon, Boyle, Bracken, Breckinridge, Bullitt, Butler, Carroll, Casey, Clark, Clay, Clinton, Cumberland, Daviess, Edmonson, Estill, Fayette, Fleming, Gallatin, Hancock, Hardin, Harrison, Hart, Henderson, Henry, Hopkins, Jackson, Jefferson, Jessamine, Knox, Larue, Lee, Lincoln, Logan, McCreary, McLean, Madison, Marion, Meade, Menifee, Mercer, Metcalfe, Monroe, Montgomery, Muhlenberg, Nelson, Nicholas, Ohio, Oldham, Owen, Owsley, Powell, Pulaski, Robertson, Rockcastle, Russell, Scott, Shelby, Simpson, Spencer, Taylor, Todd, Trigg, Trimble, Union, Warren, Washington, Wayne, Webster, Whitley, and Woodford
Counties We Serve: Bledsoe, Bradley, Campbell, Carter, Cheatham, Clay, Davidson, DeKalb, Fentress, Greene, Grundy, Hamilton, Hancock, Hawkins, Haywood, Hickman, Houston, Jackson, Johnson, Lewis, Macon, Marion, Montgomery, Moore, Morgan, Overton, Pickett, Polk, Putnam, Rhea, Robertson, Scott, Sequatchie, Shelby, Smith, Sullivan, Sumner, Trousdale, Van Buren, Warren, Washington, and White
Plan Benefits
Abilis Health Plan gives you more than what’s covered by Original Medicare.
As a Special Needs Plan (FI-SNP & IE-SNP), Abilis Health includes all the benefits of Medicare Parts A and B—plus prescription drug coverage (Part D) and added support designed for individuals who reside in a long term care facility or community.
At the heart of your care is a dedicated nurse practitioner who works closely with you and your care team to create a care plan tailored to your health goals.
Personalized Care
Dedicated Nurse Practitioner care in your facility or community.
You Pay $0*
Dental
Two preventative cleanings per year plus additional coverage for comprehensive services.
You Pay $0*
Hearing
One routine hearing exam and hearing aid fitting plus $4000 toward hearing aids every two years.
You Pay $0*
Over the Counter Benefit
Plan covers up to $400 of OTC items per quarter.
You Pay $200*
Vision
One routine eye exam, glaucoma test and eyewear benefits.
You Pay $0*
Telehealth Services
Physician and specialist services, including psychiatric services, kidney disease education services, diabetes self-management training.
You Pay $0*
Prescription Drug Coverage
Coverage for your prescriptions.
Foot Care
Routine supplemental foot care visits at your facility or community.
You Pay $0*
Healthy Food Options
Nutritious food options for residents who qualify.
You Pay $75*
Personal Care Supplies
Reliable access to daily care essentials for residents who qualify.
You Pay $75*
*$0 co-pay for these extra benefits, up to the annual limit.
All benefits will begin on January 1, 2025.
Prescription Drug Benefits
Abilis Health Plan (FI-SNP & IE-SNP) includes Medicare Part D prescription drug coverage, administered through our pharmacy benefit partner, MedImpact (formerly Elixir).
Elixir is a full-service pharmacy benefit management company committed to lowering drug costs, improving health, and providing superior customer service in a manner that instills trust and confidence.
Your deductible is $590 for Plan Year 2025.
- For Part B drugs such as chemotherapy drugs in Plan Year 2025 are 0%-20% of the cost and require an authorization. Authorization required for billed charges in excess of $250.
- Other Part B drugs in Plan Year 2025 are 0%-20% of the cost and require an authorization. Authorization required for billed charges in excess of $250.
After you pay your yearly deductible, you pay 25% of the cost for all drugs covered by this plan until your total yearly drug costs reach $2,000. Total yearly drug costs are the total drug costs paid by both you and our Part D plan.
Here’s how you can get your medications during this time:
- You may get your drugs at network retail pharmacies.
- If you reside in a long-term care facility, you pay the same as at a retail pharmacy.
- You may get drugs from an out-of-network pharmacy at the same cost as an in-network pharmacy.
The Coverage Gap Stage has been eliminated for Plan Year 2025.
Beneficiary cost-sharing has been eliminated.
For a complete list of benefits and other resources, please review your Evidence of Coverage.
Understanding Your Benefits
Additional resources to help address any questions you might have.
