Sentara Medicare Value (HMO) H2563-017-2 Plan Details
Sentara Medicare Value (HMO) H2563-017-2 Plan Details
Choosing the right Medicare Advantage plan is crucial for your healthcare needs in 2025. With Sentara Medicare Value (HMO) as one of the options, you can compare it side-by-side with other available plans to find the best fit for you. Whether you prefer enrolling online or seeking advice from a licensed agent, we’ve made the process simple and straightforward.
According to CMS enrollment data (May, 2025), there are approximately 12,141 members enrolled in this plan.
Sentara Medicare Value Overview
| Plan ID H2563-017-2 Overview | |
|---|---|
| Health Plan ID: | H2563-017-2 |
| Medicare Advantage Plan Type: | HMO |
| Plan Year: | 2025 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $3,500.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $150.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | See List |
| Insured By: | Sentara Medicare |
Plan Availability
Sentara Medicare Value (H2563-017-2) is available in the following locations (click to open):
Why Choose Sentara Medicare Value ?
This Medicare Advantage Prescription Drug (MAPD) HMO plan delivers comprehensive coverage, including hospital care, medical services, and prescription drugs — all under one roof. With a monthly premium of $0.00, you’ll get the core benefits of Medicare Part A and Part B, plus drug coverage to manage ongoing prescriptions. The annual Part D deductible is $150.00. Like most HMO plans, you’ll be asked to use in-network providers unless it’s an emergency.
Primary care visits have a not covered, specialist visits come with a $15 copay, urgent care services carry a $15 copay, and ambulance transportation is $290 copay. These costs all apply toward the plan’s annual maximum out-of-pocket (MOOP) limit of $3,500.00 . Once you hit that threshold, in-network services are fully covered for the rest of the year — helping you plan your healthcare spending with confidence.
CMS recognizes this plan as H2563-017-2. You’ll find a summary of its cost sharing below, including what you can expect to pay for primary care, specialists, urgent care, and more. Still have questions? Check the FAQ section for more details.
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Out-of-Pocket Costs
Sentara Medicare Value has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H2563-017-2.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | Not Covered |
| Specialist: | $15 Copay Prior Authorization Required |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $140 Copay |
| Urgent care: | $15 Copay |
| Ground ambulance: | $290 Copay |
| Inpatient hospital care: | $285.00 per day for days 1 through 7 $0.00 per day for days 8 and beyond |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $214.00 per day for days 21 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $10 Copay Prior Authorization Required |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $10 Copay Prior Authorization Required |
| Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $25 Copay |
| Outpatient group therapy: | $25 Copay |
| Inpatient psychiatric hospital care: | $285.00 per day for days 1 through 7 $0.00 per day for days 8 and beyond |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $20 Copay Prior Authorization Required |
| Occupational therapy: | $20 Copay Prior Authorization Required |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 20% Coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $285 Copay Prior Authorization Required |
| Lab services: | Not Covered |
| Outpatient x-rays: | $85 Copay Prior Authorization Required |
| Diagnostic tests and procedures: | $85 Copay Prior Authorization Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | Not Covered |
| Oral exam | |
| Dental x-rays | |
| Cleaning | |
| Periodontics | |
| Endodontics | |
| Restorative Services |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | Covered Limits may apply |
| Hearing aids | Covered Limits may apply |
| Hearing exam | Covered Limits may apply |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | |
| Routine eye exam (in-network) | Covered Limits may apply |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: No Eyeglass Frames: No Eyewear Upgrades: No |
Maximum eyewear benefit: | $200.00 Every year |
Certain preventive services are covered 100% by Sentara Medicare Value as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Sentara Medicare Value includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $0.00 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | ${part_d_lips_amount} |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $150.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Sentara Medicare starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Sentara Medicare Value may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic* | $0.00 | $0.00 |
| Generic* | $10.00 | $0.00 |
| Preferred Brand* | $42.00 | $42.00 |
| Non-Preferred Drug | $95.00 | $95.00 |
| Specialty Tier | 31.00% | 0.00% |
| Select Care Drugs* | $0.00 | $0.00 |
| *Deductible does not apply. | ||
How CMS Star Ratings Guide Your Choice
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Eligibility Requirements for Sentara Medicare Value
To qualify for enrollment in Sentara Medicare Value , you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
If you fulfill these criteria, you can enroll in Sentara Medicare Value and enjoy the extensive healthcare benefits it offers.
When Should You Enroll in Sentara Medicare Value ?
To ensure you don’t miss your chance to enroll in Sentara Medicare Value , be aware of these important enrollment periods:
- Initial Enrollment Period (IEP): Your IEP offers a seven-month window around your 65th birthday to sign up for Medicare.
- Annual Enrollment Period (AEP): The AEP, occurring from October 15 to December 7 each year, allows you to enroll in or make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31, the MA OEP provides an opportunity to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing insurance coverage, may qualify you for a SEP, giving you a chance to make adjustments outside the standard periods.
Need help figuring out the right time to enroll? Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) to get assistance from a licensed insurance agent.
How to Sign Up for Sentara Medicare Value
Joining Sentara Medicare Value is straightforward. Here are the steps you can take:
- Online: Use our online enrollment partner's Secure Online Enrollment Form to sign up.
- By Phone: Reach out to HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will help you with the enrollment process and answer any questions you might have.
- Through Medicare.gov: Enroll directly through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the steps to join Sentara Medicare Value .
- Direct Enrollment: You can also choose to enroll directly with Sentara Medicare Value . The contact information can be found below in the "Contact" section.
Make sure you enroll during the appropriate period to activate your coverage as soon as possible.
Here are some of the most frequently asked questions people have about plan ID H2563-017-2:
How much does H2563-017-2 cost per month?
Members pay their Part B premium and the plan's of $0.00 per month to be in this 2025 plan.
What’s the MOOP for Sentara Medicare Value in 2025?
Your costs top out at $3,500.00 (for in-network services) in 2025; after that the plan pays 100% of covered services.
How much do I pay before drug coverage starts?
You’ll pay the first $150.00 in drug costs before coinsurance kicks in.
Is this a 4-star or 5-star plan?
The latest CMS score is ★3.0 out of 5 stars; anything 4 or higher earns quality bonuses.
How many people are enrolled in this plan?
CMS reports 12,141 members in the latest file.
Contact Sentara Medicare
| Website: | Sentara Medicare Plan Page |
|---|---|
| Providers: | Sentara Medicare Providers Page |
| Formulary: | Sentara Medicare Formulary Page |
| Pharmacy: | Sentara Medicare Pharmacy Page |
| New Member Health Plan Help: | (844)563-4201 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (844)563-4201 |
| New Member Part D TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- Sentara Medicare, http://www.sentarahealthplans.com/medicare, Last Accessed June 1, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet", Last Accessed 25 May, 2025
- Medicare.gov, "Joining a plan", Last Accessed 25 May, 2025
- Medicare.gov, "Explore your Medicare coverage options", Last Accessed 25 May, 2025
- CMS.gov, Landscape Source Files, Last Accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 15, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County, Last Accessed June 6, 2025
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