In-network
Inpatient hospital
Days 1–2 $550 / day
Days 3–4 $250 / day
Days 5–90 $0 / day
Total of listed copays · 4 charged days $1,600
● CMS 2026 plan record
Aspire Health Plus (HMO-POS)
Emergency transport
Ambulance
Ground · in-network$325 copay
Air · in-network20% coinsurance
Ground ambulance: In-network: cost sharing varies by a CMS plan-defined group; Air ambulance: In-network: cost sharing varies by a CMS plan-defined group
Emergency services
Emergency room
$115 copay
Waived if admitted within 24 hours
Medical maximum
Maximum out-of-pocket
In-network$3,900
Combined in + out$3,900
Skilled care at home
Home health
In-networkVerify in plan documents
Out-of-networkNot separately reported
Monthly cost
Premium & giveback
Part C premium$246.80 / month
Consolidated C + D$366 / month
Source trail
Official CMS, Contract Year 2026
Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release. Quick-reference values should be confirmed in current official plan documents.
About this code
What H8764-002-000 identifies
H8764-002-000 is a Contract Year 2026 Medicare plan segment code. The compact form H8764002000 refers to the same normalized contract, plan, and segment shown on this page.
Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.