Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026
PruittHealth Premier, 2027
H6345Contract003Plan
HMO I-SNP · special needs plan, institutional · 13 counties in North Carolina
Run by Pruitthealth Premier North Carolina, LLC (contract H6345), sold as PruittHealth Premier, owned by UNICO Services, Inc.
PruittHealth Premier (H6345-003) costs $0 a month in 2027, with an in-network out-of-pocket limit of $5,900. It is a new plan for 2027.
What changes from 2026 to 2027?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| Monthly premium | not offered | $0 | new for 2027 |
| In-network out-of-pocket limit | not filed | $5,900 | new for 2027 |
| Drug deductible | not filed | $350 | new for 2027 |
| Primary care visit | not offered | $0 copay | changed |
| Specialist visit | not offered | $15 copay | changed |
| Emergency room | not offered | $100 copay | changed |
| Hospital stay, in network | not offered | $311 a day for days 1–7, then $0 a day for days 8–90 | changed |
| Skilled nursing facility, in network | not offered | $0 a day for days 1–20, then $50 a day for days 21–100 | changed |
| Ground ambulance, in network | not offered | $285 copay | changed |
| Eyewear, yearly limit | not offered | $500 a year | ▲added |
| Hearing aids, yearly limit for both ears | not offered | $1,250 a year | ▲added |
| 5 lines do not change | |||
| Part B premium reduction, monthly | none | none | no change |
| Medical deductible, in network | none | none | no change |
| Comprehensive dental, yearly limit | not offered | not offered | no change |
| Over-the-counter items, yearly | not offered | not offered | no change |
| Counties served | not offered | 13 | new for 2027 |
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.
What will prescriptions cost?
| Tier | What the tier holds | 2026 | 2027 |
|---|---|---|---|
| Tier 1 | Preferred Generic | not offered | $0 |
| Tier 2 | Generic | not offered | $7 |
| Tier 3 | Preferred Brand | not offered | 25% of the cost |
| Tier 4 | Non-Preferred Drug | not offered | 25% of the cost |
| Tier 5 | Specialty Tier | not offered | 29% of the cost |
Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.
How does it compare with plans sold where it is?
In the counties it serves, 8 institutional special needs plans are sold for 2027, this one included. Against the others, 1 plan has a lower out-of-pocket limit, 6 a higher one. On the premium, 2 the same, 5 a higher one.
Out-of-pocket limits of the 8 institutional special needs plans
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Where is it sold, and what does it cost there?
The premium and the out-of-pocket limit are the same in all 13 counties: $0 a month and $5,900.
North Carolina
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Who runs this plan?
- Plan ID
- H6345-003
- Legal name of the contract
- Pruitthealth Premier North Carolina, LLC
- Sold as
- PruittHealth Premier
- Parent company
- UNICO Services, Inc.
- Plan type
- HMO I-SNP
- 2026 star rating of the contract
- not rated (too little data) overall; health plan not rated, drug plan 5 of 5
- Plan website, as filed with CMS
- www.pruitthealthpremier.com
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.
What else should you check?
- Other 2027 plans in Wake, NCWhere most of its members live; premiums and limits side by side
- Every PruittHealth Premier plan for 2027Its contracts, counties and plans that end
- The other 2 plans of contract H6345Same company, same contract
- Is your prescription covered?Coverage share and tier for 2,259 drugs
Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.