English Form
PRESENTED BY
2026
Summary of Benefits
JANUARY 1–DECEMBER 31
Aspire Health Protect (HMO)
Aspire Health Value (HMO)
Aspire Health Advantage (HMO)
Aspire Health Plus (HMO-POS)
This is a summary of drug and health
services covered by Aspire Health (HMO)
January 1, 2026—December 31, 2026.
Aspire Health is an HMO plan sponsor with
a Medicare contract. Enrollment in Aspire
Health depends on contract renewal.
H8764MKTSB0825M
Aspire Health Summary of Benefits 2026 2 NOTES: Services with a 1 may require prior authorization. *Out-of-network coverage is restricted to Medicare-eligible practitioners and Medicare-covered services accessed outside of the plan’s service area of Monterey County, California. Summary of Benefits Aspire Health service area is Monterey County, California ASPIRE HEALTH PROTECT (HMO) ASPIRE HEALTH VALUE (HMO) ASPIRE HEALTH ADVANTAGE (HMO) $0 monthly plan premium in addition to your monthly Part B premium. $60.00 monthly plan premium in addition to your monthly Part B premium. $196.00 monthly plan premium in addition to your monthly Part B premium. ASPIRE HEALTH PLUS (HMO-POS) $366.00 monthly plan premium in addition to your monthly Part B premium. ASPIRE HEALTH PROTECT (HMO) ASPIRE HEALTH VALUE (HMO) ASPIRE HEALTH ADVANTAGE (HMO) This plan does not have a deductible. This plan does not have a deductible. This plan does not have a deductible. ASPIRE HEALTH PLUS (HMO-POS) This plan does not have a deductible. Monthly premium, deductible, and limits on how much you pay for covered services Monthly plan premium Medical services deductible
3
Benefit notes: Our plan also covers 60 “lifetime reserve days.” These are “extra” days that we cover. If your
hospital stay is longer than 90 days, you can use these extra days. But once you have used up these extra
60 days, your inpatient hospital coverage will be limited to 90 days.
Maximum out-of-pocket responsibility (does not include prescription drugs)
Inpatient hospital coverage1
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
$6,500 annually
The most you pay for co-pays
and co-insurance for Medicare-
covered medical benefits for the
year for services you receive from
in-network providers.
$6,000 annually
The most you pay for co-pays
and co-insurance for Medicare-
covered medical benefits for the
year for services you receive from
in-network providers.
$4,300 annually
The most you pay for co-pays
and co-insurance for Medicare-
covered medical benefits for the
year for services you receive from
in-network providers.
ASPIRE HEALTH PLUS (HMO-POS)
$3,900 in and out of service area combined
The most you pay for co-pays and co-insurance for Medicare-covered medical benefits for the year.
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
Our plan covers 90 days for an
inpatient hospital stay.
You pay $505 co-pay per day for
days 1 through 2.
You pay $300 co-pay per day for
days 3 through 4.
You pay $0 co-pay per day for
days 5 through 90.
Our plan covers 90 days for an
inpatient hospital stay.
You pay $500 co-pay per day
for days 1 through 2.
You pay $300 co-pay per day for
days 3 through 4.
You pay $0 co-pay per day for
days 5 through 90.
Our plan covers 90 days for an
inpatient hospital stay.
You pay $600 co-pay per day for
days 1 through 2.
You pay $300 co-pay per day for
days 3 through 4.
You pay $0 co-pay per day for
days 5 through 90.
ASPIRE HEALTH PLUS (HMO-POS)
Our plan covers 90 days for an inpatient hospital stay.
In network: You pay $550 co-pay per day for days 1 through 2.
You pay $250 co-pay per day for days 3 though 4.
You pay $0 co-pay per day for days 5 through 90.
Out of network*: You pay 30% co-insurance for days 1 through 90.
Aspire Health Summary of Benefits 2026
4
Outpatient
hospital
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $300 co-pay
or 20% of the cost,
depending on the
service.
You pay $300 co-pay
or 20% of the cost,
depending on the
service.
You pay $275 co-pay
or 20% of the cost,
depending on the service.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $200 co-pay or 20% of the cost, depending on the service.
Out of network: You pay 30% co-insurance.
Diagnostic
colonoscopy
and endoscopy
surgical
procedures
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $300 co-pay
per date of service.
You pay $300 co-pay
per date of service.
You pay $60 co-pay per
date of service.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $40 co-pay per date of service.
Out of network: You pay 30% co-insurance.
Wound care
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $80 co-pay
for each wound care
treatment per date
of service.
You pay $80 co-pay
for each wound care
treatment per date
of service.
You pay $60 co-pay
for each wound care
treatment per date
of service.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $40 co-pay for each wound care treatment per date of service.
Out of network*: You pay 30% co-insurance.
Outpatient hospital coverage1
5
Primary Care
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $5 co-pay per
in-person visit.
You pay $5 co-pay per
in-person visit.
You pay $0 co-pay per
in-person visit.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 co-pay per in-person visit.
Out of network: You pay 30% co-insurance per visit
Specialists1
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $45 co-pay per
in-person visit.
You pay $45 co-pay per
in-person visit.
You pay $25 co-pay per
in-person visit.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $20 co-pay per in-person visit.
Out of network: You pay 30% co-insurance per visit.
Telehealth
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $0 co-pay.
You pay $0 co-pay.
You pay $0 co-pay.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 co-pay.
Out of network: You pay 30% co-insurance.
Doctor visits
Ambulatory surgical center1
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $300 co-pay per
date of service.
You pay $300 co-pay per
date of service.
You pay $275 co-pay per
date of service.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $200 co-pay per date of service.
Out of network: You pay 30% co-insurance.
Aspire Health Summary of Benefits 2026
6
Benefit notes: If you are admitted to the hospital within 24 hours, you do not have to pay your share of the
cost for emergency care. See the “Inpatient Hospital Coverage” section of this booklet for other costs.
Benefit notes: If you are admitted to the hospital within 24 hours, you do not have to pay your share of the
cost for urgent care. See the “Inpatient Hospital Coverage” section of this booklet for other costs.
Preventive care
Urgently needed services
Emergency care
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
There is no co-insurance,
co-pay, or deductible for all
Original Medicare
preventive services.
There is no co-insurance,
co-pay, or deductible for
all Original Medicare
preventive services.
There is no co-insurance,
co-pay, or deductible for all
Original Medicare
preventive services.
ASPIRE HEALTH PLUS (HMO-POS)
There is no co-insurance, co-pay, or deductible for all Original Medicare preventive services.
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $115 co-pay per visit.
You pay $115 co-pay per visit.
You pay $115 co-pay per visit.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $115 co-pay per visit.
Out of network: You pay $115 co-pay per visit.
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $25 co-pay per visit.
You pay $25 co-pay per visit.
You pay $0 co-pay per visit.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 co-pay per visit.
Out of network*: You pay $0 co-pay per visit.
7
Diagnostic services/labs/imaging1
Diagnostic tests
and procedures
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $20 co-pay
per service.
You pay $20
co-pay per service.
You pay $10 co-pay
per service.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 co-pay per service.
Out of network: You pay 30% co-insurance for each service
Lab services
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $20 co-pay
per service.
You pay $20
co-pay per service.
You pay $10 co-pay
per service.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 co-pay per service.
Out of network: You pay 30% co-insurance for each service
General diagnostic
radiology services
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay 15%
co-insurance per service.
You pay $90
co-pay per service.
You pay $60
co-pay per service.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $30 co-pay per service.
Out of network: You pay 30% co-insurance for each service.
Complex diagnostic
radiology services
(such as CT,
PET, MRI, MRA,
Nuclear Medicine,
Angiography)
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay 15%
co-insurance per service.
You pay $250
co-pay per service.
You pay $150
co-pay per service.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $100 co-pay per service.
Out of network: You pay 30% co-insurance for each service.
Therapeutic
radiology services
(such as radiation
treatment for
cancer)
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay 20%
co-insurance per service.
You pay 20%
co-insurance per service.
You pay 20%
co-insurance per service.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay 20% co-insurance per service.
Out of network: You pay 30% co-insurance for each service.
Outpatient X-rays
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $20 co-pay
per X-ray.
You pay $20 co-pay
per X-ray.
You pay $10 co-pay
per X-ray.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 co-pay per X-ray.
Out of network: You pay 30% co-insurance for each service.
Aspire Health Summary of Benefits 2026
8
Dental services1
Hearing services
Medicare-covered
hearing exam
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $45 co-pay
for each Medicare-
covered diagnostic
hearing exam.
You pay $45 co-pay for
each Medicare-covered
diagnostic hearing exam.
You pay $25 co-pay for
each Medicare-covered
diagnostic hearing exam.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $20 co-pay.
Out of network*: You pay 30% co-insurance.
Additional
hearing services
Refer to the optional
supplemental
benefits section
for details.
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
Available in the
Enhanced Benefits
— Option B for an
additional premium of
$49.00 per month.
Available in the
Enhanced Benefits
— Option B for an
additional premium of
$49.00 per month.
Available in the
Enhanced Benefits
— Option C for an
additional premium of
$43.00 per month.
ASPIRE HEALTH PLUS (HMO-POS)
Available in the Enhanced Benefits — Option B for an additional premium of
$49.00 per month.
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
Dental coverage is limited to
services covered by Medicare
under Medicare Part A hospital
and Medicare Part B medical
benefits.
Dental coverage is limited to
services covered by Medicare
under Medicare Part A hospital
and Medicare Part B medical
benefits.
Dental coverage includes
services covered by Medicare
and preventive services
through our Delta Dental
network in Monterey County
ASPIRE HEALTH PLUS (HMO-POS)
Dental coverage is limited to services covered by Medicare under Medicare Part A hospital and
Medicare Part B medical benefits.
Additional
dental services
Refer to the optional
supplemental
benefits section
for details.
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
Available in the
Enhanced Benefits —
Options A and B for an
additional premium of
$45.00 or $49.00
per month.
Available in the
Enhanced Benefits —
Options A and B for an
additional premium of
$45.00 or $49.00
per month.
Available in the
Enhanced Benefits
— Option C for an
additional premium of
$43.00 per month.
ASPIRE HEALTH PLUS (HMO-POS)
Available in the Enhanced Benefits — Options A and B for an additional premium
of $45.00 or $49.00 per month.
9
Vision services1
Exam to diagnose
and treat diseases
and conditions of
the eye (including
yearly glaucoma
screening)
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $45 co-pay
for each Medicare-
covered exam.
You pay $45 co-pay
for each Medicare-covered
exam.
You pay $25 co-pay
for each Medicare-
covered exam.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $20 co-pay.
Out of network: You pay 30% co-insurance.
Eyeglasses or
contact lenses
after cataract
surgery
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $0 co-pay
You pay $0 co-pay
You pay $0 co-pay
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 co-pay.
Out of network: You pay 30% co-insurance.
Additional
vision services
Refer to the optional
supplemental
benefits section
for details.
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
Available in the
Enhanced Benefits —
Options A and B for an
additional premium of
$45.00 or $49.00
per month.
Available in the
Enhanced Benefits —
Options A and B for an
additional premium of
$45.00 or $49.00
per month.
Available in the
Enhanced Benefits
— Option C for an
additional premium of
$43.00 per month.
ASPIRE HEALTH PLUS (HMO-POS)
Available in the Enhanced Benefits — Options A and B for an additional premium
of $45.00 or $49.00 per month.
Additional services and benefits (not covered by Medicare) are not covered
out-of-network.
Aspire Health Summary of Benefits 2026 10 Benefit notes: Our plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital. The inpatient hospital care limit does not apply to inpatient mental services provided in a general hospital. Our plan covers 90 days for an inpatient hospital stay. Our plan also covers 60 “lifetime reserve days.” These are “extra” days that we cover. If your hospital stay is longer than 90 days, you can use these extra days. But once you have used up these extra 60 days, your inpatient hospital coverage will be limited to 90 days. Mental Health Services1 Inpatient visit ASPIRE HEALTH PROTECT (HMO) ASPIRE HEALTH VALUE (HMO) ASPIRE HEALTH ADVANTAGE (HMO) You pay $385 co-pay per day for days 1 through 5. You pay $0 co-pay per day for days 6 through 90. You pay $375 co-pay per day for days 1 through 5. You pay $0 co-pay per day for days 6 through 90. You pay $275 co-pay per day for days 1 through 6. You pay $0 co-pay per day for days 7 through 90. ASPIRE HEALTH PLUS (HMO-POS) In network: You pay $250 co-pay per day for days 1 through 5. You pay $0 co-pay per day for days 6 through 90. Out of network: You pay 30% co-insurance per day for days 1 through 90. Outpatient individual/group therapy visit ASPIRE HEALTH PROTECT (HMO) ASPIRE HEALTH VALUE (HMO) ASPIRE HEALTH ADVANTAGE (HMO) You pay 20% co-insurance . You pay $35 co-pay. You pay $15 co-pay. ASPIRE HEALTH PLUS (HMO-POS) In network: You pay $0 co-pay. Out of network: You pay 30% co-insurance.
11
Benefit notes: Our plan covers up to 100 days in a skilled nursing facility.
Skilled nursing facility1
Physical therapy1
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay 20% co-insurance for
each visit.
You pay $25 co-pay for each visit.
You pay $15 co-pay for
each visit.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 co-pay.
Out of network*: You pay 30% co-insurance.
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $0 co-pay per day for
days 1 through 20.
You pay $214 co-pay per day
for days 21 through 100.
You pay $0 co-pay per day for
days 1 through 20.
You pay $184 co-pay per day for
days 21 through 100.
You pay $0 co-pay per day
for days 1 through 20.
You pay $100 co-pay per day
for days 21 through 100.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 co-pay per day for days 1 through 20.
You pay $100 co-pay per day for days 21 through 100.Out of network: You pay 30% co-insurance per day for days 1 through 100.
Benefit notes: You must receive authorization from plan prior to utilization of non-emergency
ambulance services.
Ambulance1
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $325 co-pay via
ground transportation.
You pay 20% co-insurance via
air transportation.
You pay $325 co-pay via ground
transportation.
You pay 20% co-insurance via
air transportation.
You pay $325 co-pay via
ground transportation.
You pay 20% co-insurance via
air transportation.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $325 co-pay via ground transportation.
You pay 20% co-insurance via air transportation.
Out of network: You pay $325 co-pay via ground transportation.
You pay 30% co-insurance via air transportation.
Aspire Health Summary of Benefits 2026
12
Benefit notes: To arrange transportation, please contact the plan 3 business days in advance to allow for
proper scheduling.
Benefit notes: Prior Authorization and step therapy rules may apply.
Medicare Part B drugs1
Transportation1
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $35 for Part B insulin.
You pay 20% co-insurance for
all other Part B drugs, including
chemotherapy.
You pay $35 for Part B insulin.
You pay 20% co-insurance for
all other Part B drugs, including
chemotherapy.
You pay $35 for Part B insulin.
You pay 20% co-insurance
for all other Part B drugs,
including chemotherapy.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $35 for Part B insulin.
You pay 20% co-insurance for all other Part B drugs, including chemotherapy.
Out of network*: You pay $35 for Part B insulin. You pay 30% co-insurance for all other Part B drugs,
including chemotherapy.
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $0 co-pay.
6 one-way trips each year to
routine in-network appointments.
You pay $0 co-pay.
6 one-way trips each year to
routine in-network appointments.
You pay $0 co-pay.
12 one-way trips each
year to routine in-network
appointments.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 co-pay.
12 one-way trips each year to routine in-network appointments.
Out of network: Routine transportation is not covered out of network
13
Foot care (podiatry services)
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay 20% of the cost for
each durable medical equipment
or supply.
You pay 20% of the cost for
each durable medical equipment
or supply.
You pay 20% of the cost
for each durable medical
equipment or supply.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay 20% of the cost for each durable medical equipment or supply.
Out of network: You pay 30% co-insurance.
Foot exams and
treatment if you
have diabetes-
related nerve
damage and/or
meet certain
conditions
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $45 co-pay.
You pay $45 co-pay.
You pay $25 co-pay.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $20 co-pay.
Out of network: You pay 30% co-insurance.
Medical equipment/supplies1
Rehabilitation services1
Pulmonary rehab
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay 20% co-insurance
for each visit.
You pay $15 co-pay for
each visit.
You pay $15 co-pay
for each visit.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 co-pay.
Out of network: You pay 30% co-insurance.
Speech,
occupational,
cardiac therapy
visit
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay 20% co-insurance
for each visit.
You pay $25 co-pay for
each visit.
You pay $15 co-pay
for each visit.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 co-pay.
Out of network: You pay 30% co-insurance.
Additional benefits
Aspire Health Summary of Benefits 2026
14
Fitness benefit
Acupuncture
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $0 co-pay for the
fitness benefit. Benefit includes
physical fitness exclusively at the
Montage Wellness Center.
You pay $0 co-pay for the fitness
benefit. Benefit includes physical
fitness exclusively at the Montage
Wellness Center.
You pay $0 co-pay for the
fitness benefit. Benefit
includes physical fitness
exclusively at the Montage
Wellness Center.
ASPIRE HEALTH PLUS (HMO-POS)
You pay $0 co-pay for the fitness benefit. Benefit includes physical fitness exclusively at the
Montage Wellness Center.
Medicare-covered
visit for chronic
low back pain
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $0 per visit for
up to 12 visits in 90 days,
with no more than 20
treatments annually.
You pay $0 per visit for
up to 12 visits in 90 days,
with no more than 20
treatments annually.
You pay $0 per visit
for up to 12 visits in
90 days, with no more
than 20 treatments
annually.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 per visit for up to 12 visits in 90 days, with no more than
20 treatments annually.
Out of network: You pay 30% of the cost per visit for up to 12 visits in 90 days,
with no more than 20 treatments annually.
Routine
acupuncture
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $20 per visit
(for up to 4 visits
every year).
You pay $20 per visit
(for up to 4 visits
every year).
You pay $10 per visit
(for up to 6 visits
every year).
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 co-pay per visit (for up to 12 visits every year).
Out of network: Routine acupuncture is not covered out of network.
15 Benefit notes: Routine chiropractic visits are limited to manual manipulation of the spine that is supportive, not corrective. This is sometimes called maintenance therapy or maintenance care. Routine chiropractic services are limited to the following codes: 98940, 98941, or 98942. Benefit notes: Diabetic monitoring supplies obtained through our Part D prescription drug benefit are limited to Abbott Diabetes Care, the maker of FreeStyle and Precision brand products. A 20% co-insurance applies to continuous glucose monitor (CGM) equipment and supplies. Chiropractic care Diabetes supplies and services1 Medicare- covered visit for manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position) ASPIRE HEALTH PROTECT (HMO) ASPIRE HEALTH VALUE (HMO) ASPIRE HEALTH ADVANTAGE (HMO) You pay $15 co-pay per visit. You pay $10 co-pay per visit. You pay a $10 co-pay per visit. ASPIRE HEALTH PLUS (HMO-POS) In network: You pay $0 co-pay. Out of network: You pay 30% co-insurance. Routine chiropractic visit ASPIRE HEALTH PROTECT (HMO) ASPIRE HEALTH VALUE (HMO) ASPIRE HEALTH ADVANTAGE (HMO) You pay a $20 co-pay per visit (for up to 4 visits every year). You pay a $20 co-pay per visit (for up to 4 visits every year). You pay $10 per visit (for up to 6 visits every year). ASPIRE HEALTH PLUS (HMO-POS) In network: You pay $0 co-pay(for up to 12 visits every year). Out of network: Routine chiropractic care is not covered out of network. Diabetes monitoring supplies, self-management training, therapeutic shoes and inserts therapeutic shoes and inserts ASPIRE HEALTH PROTECT (HMO) ASPIRE HEALTH VALUE (HMO) ASPIRE HEALTH ADVANTAGE (HMO) You pay 0–20% co-insurance. You pay 0–20% co-insurance. You pay 0–20% co-insurance. ASPIRE HEALTH PLUS (HMO-POS) In network: You pay 0–20% co-insurance. Out of network*: You pay 30% co-insurance.
Aspire Health Summary of Benefits 2026
16
Benefit notes: Our plan covers the costs of Medicare-covered home health services.
Home health care1
Outpatient substance abuse
Prosthetic devices (braces, artificial limbs, etc.)1
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $0 co-pay.
You pay $0 co-pay.
You pay $0 co-pay.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 co-pay.
Out of network: You pay 30% co-insurance.
Group/individual
therapy visit
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay 20%
co-insurance.
You pay $35 co-pay.
You pay $15 co-pay.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay $0 co-pay.
Out of network: You pay 30% co-insurance.
Prosthetic devices
and related
medical supplies
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay 20%
co-insurance.
You pay 20%
co-insurance.
You pay 20%
co-insurance.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay 20% co-insurance.
Out of network*: You pay 30% co-insurance.
17
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay 20% of the cost.
You pay 20% of the cost.
You pay 20% of the cost.
ASPIRE HEALTH PLUS (HMO-POS)
In network: You pay 20% of the cost.
Out of network*: You pay 20% of the cost.
ASPIRE HEALTH
PROTECT (HMO)
ASPIRE HEALTH
VALUE (HMO)
ASPIRE HEALTH
ADVANTAGE (HMO)
You pay $0 co-pay for hospice
care from a Medicare-certified
hospice. You may have to pay
part of the cost for drugs and
respite care.
You pay $0 co-pay for hospice
care from a Medicare-certified
hospice. You may have to pay
part of the cost for drugs and
respite care.
You pay $0 co-pay for
hospice care from a
Medicare-certified hospice.
You may have to pay part
of the cost for drugs and
respite care.
ASPIRE HEALTH PLUS (HMO-POS)
You pay $0 co-pay for hospice care from a Medicare-certified hospice. You may have to pay part of the
cost for drugs and respite care.
Renal dialysis1
Hospice
Aspire Health Summary of Benefits 2026 18 Cost-Sharing may change depending on the pharmacy you choose and when you enter another phase of the Part D benefit. For more information on the additional pharmacy-specific cost-sharing and the phases of the benefit, please call us or access our Evidence of Coverage online. STANDARD MAIL ORDER COST-SHARING Tier Three-month supply Tier 1 (Preferred Generic) $18 co-pay Tier 2 (Generic) $40 co-pay Tier 3 (Preferred Brand) $94 co-pay Tier 4 (Non-Preferred Drug) Not available Tier 5 (Specialty Tier) Not available Tier 6 (Select Care Drugs) $22 co-pay STANDARD MAIL ORDER COST-SHARING Tier Three-month supply Tier 1 (Preferred Generic) $18 co-pay Tier 2 (Generic) $40 co-pay Tier 3 (Preferred Brand) $94 co-pay Tier 4 (Non-Preferred Drug) Not available Tier 5 (Specialty Tier) Not available Tier 6 (Select Care Drugs) $22 co-pay Outpatient prescription drug benefits ASPIRE HEALTH PROTECT (HMO) ASPIRE HEALTH VALUE (HMO) STANDARD RETAIL COST-SHARING Tier One-month supply Three-month supply Tier 1 (Preferred Generic) $9 co-pay $27 co-pay Tier 2 (Generic) $20 co-pay $60 co-pay Tier 3 (Preferred Brand) $47 co-pay $141 co-pay Tier 4 (Non-Preferred Drug) 25% of the cost Not available Tier 5 (Specialty Tier) 33% of the cost Not available Tier 6 (Select Care Drugs) $11 co-pay $33 co-pay STANDARD RETAIL COST-SHARING Tier One-month supply Three-month supply Tier 1 (Preferred Generic) $9 co-pay $27 co-pay Tier 2 (Generic) $20 co-pay $60 co-pay Tier 3 (Preferred Brand) $47 co-pay $141 co-pay Tier 4 (Non-Preferred Drug) 25% of the cost Not available Tier 5 (Specialty Tier) 33% of the cost Not available Tier 6 (Select Care Drugs) $11 co-pay $33 co-pay Initial Coverage No deductible. Initial Coverage No deductible.
19 Cost-Sharing may change depending on the pharmacy you choose and when you enter another phase of the Part D benefit. For more information on the additional pharmacy-specific cost-sharing and the phases of the benefit, please call us or access our Evidence of Coverage online. STANDARD MAIL ORDER COST-SHARING Tier Three-month supply Tier 1 (Preferred Generic) $8 co-pay Tier 2 (Generic) $30 co-pay Tier 3 (Preferred Brand) $94 co-pay Tier 4 (Non-Preferred Drug) Not available Tier 5 (Specialty Tier) Not available Tier 6 (Select Care Drugs) $22 co-pay STANDARD MAIL ORDER COST-SHARING Tier Three-month supply Tier 1 (Preferred Generic) $0 co-pay Tier 2 (Generic) $20 co-pay Tier 3 (Preferred Brand) $90 co-pay Tier 4 (Non-Preferred Drug) Not available Tier 5 (Specialty Tier) Not available Tier 6 (Select Care Drugs) $22 co-pay Outpatient prescription drug benefits ASPIRE HEALTH ADVANTAGE (HMO) ASPIRE HEALTH PLUS (HMO-POS) STANDARD RETAIL COST-SHARING Tier One-month supply Three-month supply Tier 1 (Preferred Generic) $4 co-pay $12 co-pay Tier 2 (Generic) $15 co-pay $45 co-pay Tier 3 (Preferred Brand) $47 co-pay $141 co-pay Tier 4 (Non-Preferred Drug) 25% of the cost Not available Tier 5 (Specialty Tier) 33% of the cost Not available Tier 6 (Select Care Drugs) $11 co-pay $33 co-pay STANDARD RETAIL COST-SHARING Tier One-month supply Three-month supply Tier 1 (Preferred Generic) $0 co-pay $0 co-pay Tier 2 (Generic) $10 co-pay $30 co-pay Tier 3 (Preferred Brand) $45 co-pay $135 co-pay Tier 4 (Non-Preferred Drug) 25% of the cost Not available Tier 5 (Specialty Tier) 33% of the cost Not available Tier 6 (Select Care Drugs) $11 co-pay $33 co-pay Initial Coverage No deductible. Initial Coverage No deductible.
Aspire Health Summary of Benefits 2026 20 CATASTROPHIC COVERAGE: After your yearly out-of-pocket drug costs reach $2,100 in 2026, you pay nothing for covered Part D drugs. TRANSITION COVERAGE FOR NEW MEMBERS: For outpatient drugs, up to one (1) 30-day transition fills of Part D prescription medications, during the first 90 days of new membership in our plan. If you are in a Long Term Care Facility you can get up to one (1) 31-day transition fills of Part D prescription medications, during the first 90 days of new membership in our plan. Outpatient prescription drug benefits
21 Enhanced Benefits — Option A for the PROTECT, VALUE, and PLUS plans $45.00 in additional premium per month if you choose to enroll in this optional coverage. This optional supplemental benefit includes dental and vision coverage: Dental coverage is through Delta Dental™ Medicare Advantage Network for Aspire Health Plan and includes: ■ Preventive services: You pay $0 co-pay. ■ Comprehensive co-insurance: 20%–50% ■ Plan pays up to $1,000 every year Vision coverage is through VSP™ Vision Care and includes: ■ Yearly routine eye exam: $10 co-pay ■ Eyewear: $25 co-pay ■ $150 allowance for frames or contacts Optional supplemental benefits Enhanced Benefits — Option B for the PROTECT, VALUE, and PLUS plans $49.00 in additional premium per month if you choose to enroll in this optional coverage. This optional supplemental benefit includes dental, vision, hearing, additional transportation, and post discharge home-delivered meals: Dental coverage is through Delta Dental™ Medicare Advantage Network for Aspire Health Plan and includes: ■ Preventive services: You pay $0 co-pay. ■ Comprehensive co-insurance: 20%–50% ■ Plan pays up to $1,000 every year Vision coverage is through VSP™ Vision Care and includes: ■ Yearly routine eye exam: $10 co-pay ■ Eyewear: $25 co-pay ■ $150 allowance for frames or contacts Hearing coverage is through TruHearing™ and includes: ■ Yearly routine hearing exam: $20 co-pay ■ Hearing aids: $599 or $899 co-pay, one hearing aid per ear, per year Transportation includes: ■ Additional 10 one-way rides to in-network appointments: You pay $0 co-pay. Home-delivered meals includes: ■ 14 refrigerated meals, 2 meals per day for 7 days, customized to the member’s preference: You pay $0 co-pay. ■ Meal benefit must be requested within 14 days following discharge from an acute care facility admission ■ Meals for certain chronic conditions for a temporary period Plans may offer supplemental benefits in addition to Part C benefits and Part D benefits.
Aspire Health Summary of Benefits 2026 22 Enhanced Benefits — Option C for the ADVANTAGE plan $43.00 in additional premium per month if you choose to enroll in this optional coverage. This optional supplemental benefit includes dental, vision, hearing, additional transportation, and post discharge home-delivered meals: Dental coverage is through Delta Dental™ Medicare Advantage Network for Aspire Health Plan and includes: ■ Comprehensive co-insurance: 20%–50% ■ Plan pays up to $1,000 every year Vision coverage is through VSP™ Vision Care and includes: ■ Yearly routine eye exam: $10 co-pay ■ Eyewear: $25 co-pay ■ $150 allowance for frames or contacts Hearing coverage is through TruHearing™ and includes: ■ Yearly routine hearing exam: $20 co-pay ■ Hearing aids: $599 or $899 co-pay, one hearing aid per ear, per year Transportation includes: ■ Additional 10 one-way rides to in-network appointments: You pay $0 co-pay. Home-delivered meals includes: ■ 14 refrigerated meals, 2 meals per day for 7 days, customized to the member’s preference: You pay $0 co-pay. ■ Meal benefit must be requested within 14 days following discharge from an acute care facility admission ■ Meals for certain chronic conditions for a temporary period Check the Evidence of Coverage (EOC) for specific coverage information and limitations. You will have a ninety (90) day grace period from your Medicare Advantage Prescription Drug (MAPD) enrollment effective date to add the Enhanced Benefits. After the grace period ends, you may not elect the Enhanced Benefits until the next annual enrollment period.
23 Before making an enrollment decision, it is important that you fully understand our benefits and rules. If you have any questions, you can call and speak to a customer service representative at (888) 864-4611. Understanding the Benefits □ Review the full list of benefits found in the Evidence of Coverage (EOC), especially those services for which you routinely see a doctor. Visit www.aspirehealthplan.org or call (888) 864-4611 (TTY 711) to view a copy of the EOC. □ Review the provider directory (or ask your doctor) to make sure the doctors you see now are in the network. If they are not listed, it means you will likely have to select a new doctor. □ Review the pharmacy directory to make sure the pharmacy you use for any prescription medicines is in the network. If the pharmacy is not listed, you will likely have to select a new pharmacy for your prescriptions. □ Review the formulary to make sure your drugs are covered. Understanding Important Rules □ In addition to your monthly plan premium, you must continue to pay your Medicare Part B premium. This premium is normally taken out of your Social Security check each month. □ If you are currently enrolled in a Medicare Advantage plan, your current Medicare Advantage healthcare coverage will end once your new Medicare Advantage coverage starts. If you have Tricare, your coverage may be affected once your new Medicare Advantage coverage starts. Please contact Tricare for more information. If you have a Medigap plan, once your Medicare Advantage coverage starts, you may want to drop your Medigap policy because you will be paying for coverage you cannot use. □ Benefits, premiums and/or co-payments/co-insurance may change next calendar year. □ Except in emergency or urgent situations, we do not cover services by out-of-network providers (doctors who are not listed in the provider directory). □ Our Aspire Health Plus (HMO-POS) plan allows you to see out-of-network (non-contracted) providers outside of Monterey County. However, while we pay for covered services provided by a non-contracted provider, the provider must agree to treat you. Except in emergency or urgent situations, non-contracted providers may deny care. H8764MKTPreChecklist0825C Pre-enrollment checklist
Aspire Health Summary of Benefits 2026 24
Notice of Availability of Language Assistance Services and Auxiliary Aids and Services
English: ATTENTION: If you speak English, free language assistance services
are available to you. Appropriate auxiliary aids and services to provide information in
accessible formats are also available free of charge. Call 855-570-1600, (TTY: 711) or
speak to your provider.
Español: ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de
asistencia lingüística. También están disponibles de forma gratuita ayuda y servicios auxiliares
apropiados para proporcionar información en formatos accesibles. Llame al 855-570-1600,
(TTY: 711) o hable con su proveedor.
Simplified Chinese: 中文: 注意:如果您说[中文],我们将免费为您提供语言协助服务。我
们还免费提供适当的辅助工具和服务,以无障碍格式提供信息。致电 1-855-570-1600,(文本
电话:711)或咨询您的服务提供商。
Tagalog: PAALALA: Kung nagsasalita ka ng Tagalog, magagamit mo ang mga libreng serbisyong
tulong sa wika. Magagamit din nang libre ang mga naaangkop na auxiliary na tulong at serbisyo
upang magbigay ng impormasyon sa mga naa-access na format. Tumawag sa 1-855-570-1600, (TTY:
711) o makipag-usap sa iyong provider.
Vietnamese: Việt: LƯU Ý: Nếu bạn nói tiếng Việt, chúng tôi cung cấp miễn phí các dịch
vụ hỗ trợ ngôn ngữ. Các hỗ trợ dịch vụ phù hợp để cung cấp thông tin theo các định dạng
dễ tiếp cận cũng được cung cấp miễn phí. Vui lòng gọi theo số 1-855-570-1600 (Người
khuyết tật: 711) hoặc trao đổi với người cung cấp dịch vụ của bạn.
Korean: 한국어: 주의: [한국어]를 사용하시는 경우 무료 언어 지원 서비스를 이용하실 수
있습니다. 이용 가능한 형식으로 정보를 제공하는 적절한 보조 기구 및 서비스도 무료로
제공됩니다. 1-855-570-1600 (TTY: 711) 번으로 전화하거나 서비스 제공업체에 문의하십시오.
French: Français: ATTENTION: Si vous parlez Français, des services d'assistance
linguistique gratuits sont à votre disposition. Des aides et services auxiliaires appropriés
pour fournir des informations dans des formats accessibles sont également disponibles
gratuitement. Appelez le 1-855-570-1600, (TTY: 711) ou parlez à votre fournisseur.
Brazilian Portuguese: Português do Brasil: ATENÇÃO: Se você fala [inserir idioma],
serviços gratuitos de assistência linguística estão disponíveis para você. Auxílios e
serviços auxiliares apropriados para fornecer informações em formatos acessíveis
também estão disponíveis gratuitamente. Ligue para 1-855-570-1600, (TTY: 711)
ou fale com seu provedor.
Hindi: िहंदी : ȯान दें: यिद आप िहंदी बोलते हैं, तो आपके िलए िनःशुʋ भाषा सहायता सेवाएं उपलɩ होती हैं। सुलभ प्रारूपों में जानकारी प्रदान करने के िलए उपयुƅ सहायक साधन और सेवाएँ भी िनःशुʋ उपलɩ हैं। 1-855-570-1600, (TTY: 711) पर कॉल करें या अपने प्रदाता से बात करें।
25
: Farsi ﻓﺎر᤻ي
ﺗﻮﺟﻪ:
اឞﺮ ] وارد ﮐﺮدن زᘿﺎن[ ﺻﺤبﺖ ᥍ ﮐﻨᚗﺪ، ﺧﺪﻣﺎت ᜩﺸتﯿبﺎین زᘿﺎین راᙶگﺎن در دﺳᤫت س ﺷﻤﺎ ﻗﺮار دارد.
ﻫﻤﭽﻨنی ن کﻤﮏ ﻫﺎ و ﺧﺪﻣﺎت ᜩﺸتﯿبﺎین ﻣﻨﺎﺳﺐ ﺑﺮای اراﺋﻪ اﻃﻼﻋﺎت در ﻗﺎﻟﺐ ﻫﺎی ﻗﺎبﻞ دﺳᤫت س، بﻪ ﻃﻮر راᙶگﺎن ﻣﻮﺟﻮد ᥍ بﺎﺷﻨﺪ.
بﺎ ﺷﻤﺎرە 1-855-570-1600
)ﺗﻠﻪ ﺗﺎᙶﭗ: 711 (ﺗﻤﺎس بﮕᤫیᙕﺪ ᙶﺎ بﺎ اراﺋﻪ دﻫﻨﺪە ﺧﻮد ﺻﺤبﺖ ﮐﻨᚗﺪ.
:Arabic
اﻟﻌرﺑﯾﺔ
ﺗﻧﺑﯾﮫ:
إذا ﻛﻧت ﺗﺗﺣدث اﻟﻠﻐﺔ اﻟﻌرﺑﯾﺔ ، ﻓﺳﺗﺗوﻓر ﻟك ﺧدﻣﺎت اﻟﻣﺳﺎﻋدة اﻟﻠﻐوﯾﺔ اﻟﻣﺟﺎﻧﯾﺔ.
ﻛﻣﺎ ﺗﺗوﻓر وﺳﺎﺋل ﻣﺳﺎﻋدة وﺧدﻣﺎت ﻣﻧﺎﺳﺑﺔ ﻟﺗوﻓﯾر اﻟﻣﻌﻠوﻣﺎت ﺑﺗﻧﺳﯾﻘﺎت ﯾﻣﻛن اﻟوﺻول إﻟﯾﮭﺎ ﻣﺟﺎﻧًﺎ.
اﺗﺻل ﻋﻠﻰ اﻟرق1-855-570-1600, (TTY: 711)
."أو ﺗﺣدث إﻟﻰ ﻣﻘدم اﻟﺧدﻣﺔ
Armenian: ՀԱՅԵՐԵՆ: ՈՒՇԱԴՐՈՒԹՅՈՒՆ. Եթե խոսում եք հայերեն, Դուք կարող եք օգտվել լեզվական աջակցության անվճար ծառայություններից: Մատչելի ձևաչափերով տեղեկատվություն տրամադրելու համապատասխան օժանդակ միջոցներն ու ծառայությունները նույնպես տրամադրվում են անվճար: Զանգահարեք 1-855-570-1600, (TTY: 711) հեռախոսահամարով (TTY: 711) կամ խոսեք Ձեր մատակարարի հետ: Russian: РУССКИЙ: ВНИМАНИЕ: Если вы говорите на русский, вам доступны бесплатные услуги языковой поддержки. Соответствующие вспомогательные средства и услуги по предоставлению информации в доступных форматах также предоставляются бесплатно. Позвоните по телефону 1-855-570-1600, (TTY: 711) или обратитесь к своему поставщику услуг. Punjabi: ਪੰਜਾਬੀ: ਿਧਆਨ ਿਦਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਦੇ ਹੋ, ਤਾਂ ਤੁਹਾਡੇ ਲਈ ਮੁਫ਼ਤ ਭਾਸ਼ਾ ਸਹਾਇਤਾ ਸੇਵਾਵਾਂ ਉਪਲਬਧ ਹੁੰਦੀਆਂ ਹਨ। ਪਹੁੰਚਯੋਗ ਫਾਰਮੈਟਾਂ ਿਵੱਚ ਜਾਣਕਾਰੀ ਪਦਾਨ ਕਰਨ ਲਈ ਢੁਕਵੇਂ ਪੂਰਕ ਸਹਾਇਕ ਸਾਧਨ ਅਤੇ ਸੇਵਾਵਾਂ ਵੀ ਮੁਫ਼ਤ ਿਵੱਚ ਉਪਲਬਧ ਹੁੰਦੀਆਂ ਹਨ। 1-855-570-1600, (TTY: 711) ‘ਤੇ ਕਾਲ ਕਰੋ ਜਾਂ ਆਪਣੇ ਪਦਾਤਾ ਨਾਲ ਗੱਲ ਕਰੋ। Japanese: 日本語: 注:日本語を話される場合、無料の言語支援サービスをご利 用いただけます。アクセシブル(誰もが利用できるよう配慮された)な形式で情報を 提供するための適切な補助支援やサービスも無料でご利用いただけます。1-855- 570-1600, (TTY: 711) までお電話ください。または、ご利用の事業者にご相談ください。 German: Deutsch: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlose Sprachassistenzdienste zur Verfügung. Entsprechende Hilfsmittel und Dienste zur Bereitstellung von Informationen in barrierefreien Formaten stehen ebenfalls kostenlos zur Verfügung. Rufen Sie 1-855-570-1600, (TTY: 711) an oder sprechen Sie mit Ihrem Provider. H8764NOA0825_C
Aspire Health Summary of Benefits 2026 26 Aspire Health is a Medicare Advantage HMO plan sponsor with a Medicare contract. Enrollment in Aspire Health depends on contract renewal. Other providers are available in our network. The benefit information provided is a summary of what we cover and what you pay. It does not list every service that we cover or list every limitation or exclusion. To get a complete list of services we cover, please request the “Evidence of Coverage.” You can see the Evidence of Coverage on our website at www.aspirehealthplan.org or by calling Member Services (855) 570-1600 (TTY:711) to request a copy. This document is available in other formats such as large print. We are open 8 a.m.–8 p.m. PT Monday through Friday from April 1 through September 30 and 8 a.m.–8 p.m. PT seven days a week from October 1 through March 31 (except certain holidays). To join Aspire Health , you must be entitled to Medicare Part A, be enrolled in Medicare Part B, and live in our service area. Our service area is Monterey County, California. Aspire Health has a network of doctors, hospitals, pharmacies, and other providers. If you use the providers that are not in our network, the plan may not pay for these services. For coverage and costs of Original Medicare, look in your current “Medicare & You” handbook. View it online at http://www.medicare.gov or get a copy by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
Your Medicare Advantage. All-in-one plans. Exceptional service. Great value. PRESENTED BY Member Services (855) 570-1600 (TTY:711) 10 Ragsdale Drive, Suite 101 | Monterey, CA 93940 www.aspirehealthplan.org
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