Benefits & 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 $200 of OTC items per quarter.
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
Receive up to $75 per month in nutritious food options for residents who qualify.
Personal Care Supplies
Reliable access to up to $75 per month in daily care essentials for residents who qualify.
*$0 co-pay for these extra benefits, up to the annual limit.
All benefits will begin on January 1, 2026.
Download Full Benefits List for Abilis Health Plan
Download Full Benefits List for Abilis Health Community Plan
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.
