Troy Medicare (HMO)
3.0 stars — Average. CMS rated contract H4676 3.0 out of 5 for 2026; every plan under H4676 carries the same rating. The rating measures the contract's past quality, member experience and service as CMS scored it (largely 2024 performance); it is not a recommendation. How CMS star ratings work
Summary of Benefits Where to find this plan's 2026 Summary of Benefits.
Cost sharing reported by CMS
| Primary care visit copay (minimum reported) | — |
| Specialist visit copay (minimum reported) | — |
| Urgent care copay | — |
| Emergency room copay | $110 |
"Minimum reported" is the lowest copay in the plan's bid for that service category; the plan may charge more for some providers or settings. "—" means CMS did not publish a value.
Supplemental benefits
| Benefit | Reported in bid | Allowance / plan maximum |
|---|---|---|
| Preventive dental | Yes | $3,000 |
| Comprehensive dental | Yes | Reported |
| Vision exam | Yes | $50 |
| Eyewear | Yes | $200 |
| Hearing exam | Yes | Reported |
| Hearing aids | Yes | Reported |
| Transportation | Yes | Reported |
| OTC allowance | Yes | $20 |
| Meals | No | — |
| Acupuncture | No | — |
| Chiropractic | No | — |
| Telehealth | Yes | Reported |
| Food / produce | — | — |
| Utilities support | — | — |
"Yes" means the plan's approved bid reports the benefit; it does not describe limits, frequency, networks, or eligibility. An allowance is the plan maximum CMS published for that benefit, per the period the plan defines. "Reported" means the benefit is offered but no amount was published.
Professional view: governed benefit records (14)
| Benefit | Code | Offered |
|---|---|---|
| Preventive dental | PREVENTIVE_DENTAL | Yes |
| Comprehensive dental | COMPREHENSIVE_DENTAL | Yes |
| Vision exam | VISION_EXAM | Yes |
| Eyewear | EYEWEAR | Yes |
| Hearing exam | HEARING_EXAM | Yes |
| Hearing aid | HEARING_AID | Yes |
| Transportation | TRANSPORTATION | Yes |
| Over-the-counter | OTC | Yes |
| Meals | MEALS | No |
| Acupuncture | ACUPUNCTURE | No |
| Chiropractic | CHIROPRACTIC | No |
| Telehealth | TELEHEALTH | Yes |
| Food and produce | FOOD_PRODUCE | — |
| Utilities support | UTILITIES | — |
Prior-year plan lineage (CMS crosswalk)
H4676-001: Renewal Plan
Part D drug coverage
Formulary 00026314 · Part D deductible $0 · 6 tiers, per the CMS monthly formulary file.
Check a drug on this plan
Tier cost sharing
| Tier | Deductible applies | 30-day preferred retail | 30-day standard retail | 90-day preferred mail |
|---|---|---|---|---|
| 1 | No | $0 | $10 | — |
| 2 | No | $5 | $20 | — |
| 3 | No | $25 | $40 | — |
| 4 | No | $100 | $100 | — |
| 5 specialty | No | 33% | 33% | — |
| 6 | No | $0 | $0 | — |
Initial-coverage cost sharing as filed with CMS. A copay is shown in dollars, coinsurance as a percentage; "—" means that pharmacy type is not offered for the tier. Insulin is capped at $35 per month's supply by law; selected drugs under Medicare price negotiation have negotiated prices.
Pharmacies near you in this plan's network
Source: pharmacy network file in the CMS monthly Part D formulary release of 09/16/2026; pharmacy names, addresses and phone numbers from the CMS NPPES NPI registry. Distances are between ZIP code centers (Census 2020), so they are approximate. Networks change during the year: call the pharmacy or the plan to confirm before you fill a prescription.
Service area (35 counties)
Need help with this plan?
Member services: call the number on your member ID card, or the plan's website below.
Plan website: www.troymedicare.com ↗
Medicare: 1-800-MEDICARE (1-800-633-4227) (TTY 1-877-486-2048) · Free counseling (SHIP): 1-877-839-2675
Report a data issue on this page
What the star rating means. CMS rates every Medicare Advantage contract (the "H" number in the plan ID — all plans under it share the rating) on a 1-to-5 scale each October, from about 40 measures of care quality, member experience, complaints and appeals, customer service and, for plans with drug coverage, drug safety and pricing. The 2026 rating is largely based on performance measured in 2024.
5 Excellent4 Above average3 Average2 Below average1 Poor
Not rated means CMS published no overall rating — usually a contract too new to be measured or with too few members ("not enough data"); it is not a low score. A 5-star contract can be joined outside the normal enrollment windows (the 5-star Special Enrollment Period, Dec 8 – Nov 30). Medicare.gov flags contracts rated below 3 stars for three years running as low-performing. Stars describe the contract's past performance as CMS measured it; they are not a recommendation, and they do not tell you whether a plan's network, drugs or costs fit you.
Source and definitions
Fields come from the CMS Plan Benefit Package (PBP) and landscape public use files for contract year 2026 (see the source ledger). Premium is the CMS consolidated monthly premium. MOOP is the in-network maximum out-of-pocket. Star rating is the contract's overall rating from the CMS file used in this build; "Not rated" means CMS published none for this contract. This page reports filings and does not recommend or sell any plan; the plan's Summary of Benefits and Evidence of Coverage govern.