PruittHealth Premier

What PruittHealth Premier does

PruittHealth Premier is a privately held Medicare Advantage Special Needs Plan (SNP) operating under CMS contracts (H6345 and H3291) and headquartered in Glen Allen, Virginia. The company serves Medicare beneficiaries across Georgia, North Carolina, and South Carolina through three core product lines: a Dual-Eligible Special Needs Plan (HMO D-SNP) for Medicare-Medicaid beneficiaries, Institutional Special Needs Plans (HMO I-SNP) for long-term-care-eligible beneficiaries (including a $0-premium tier), and sub-brands Align Thrive (HMO I-SNP) and Align Connect (HMO C-SNP for dementia). Monthly premiums range from $0 to $36.20 depending on plan type and subsidy eligibility, with Part D prescription drug coverage included and a $2,100 Part D out-of-pocket cap for 2026.

The company's technology platform consists of HealthX-powered HIPAA-compliant Member and Provider self-service portals, an AllyAlign-implemented CMS-9115-F and ONC 21st Century Cures Act compliant Interoperability API, and a curated vendor ecosystem for non-core capabilities: Navitus Health Solutions for pharmacy benefit management (including Medication Therapy Management), Liberty Dental for dental benefits, Nations Benefits for hearing benefits, Helper Bees for additional supplemental benefits, and MCG for evidence-based clinical criteria used in utilization management. The company maintains URAC accreditation and NCQA HEDIS compliance, and reports CMS quality metric performance in medication review, preventive care visits, and care transition follow-up.

PruittHealth Premier is a subsidiary of PruittHealth, a post-acute and long-term care organization founded in 1969 that operates more than 90 skilled nursing, assisted living, and post-acute facilities across Georgia, North Carolina, South Carolina, and Florida. Distribution leverages this captive facility network through provider referrals, supplemented by a licensed broker/agent network, direct-to-consumer website enrollment, and the CMS Medicare.gov marketplace. The company employs 51–100 staff and reports revenue that is not publicly disclosed.

Name

PruittHealth Premier

Legal name

PruittHealth Premier

Website

https://pruitthealthpremier.com

Company type

Private

Founded year

1969

Operating status

Operating

Headcount range

51–100 employees

Short description

PruittHealth Premier is a CMS-contracted Medicare Advantage Special Needs Plan (SNP) offering D-SNP, I-SNP, and C-SNP products to institutionalized, dual-eligible, and chronically ill Medicare beneficiaries in Georgia, North Carolina, and South Carolina, as a subsidiary of PruittHealth.

Ownership category

akta.pro rank

Product category

Medicare Advantage Insurance

NAICS

Direct Life, Health, and Medical Insurance Carriers (52411)

SIC

Accident & Health Insurance (6321), Hospital & Medical Service Plans (6324)

akta.pro primary industry

MA Special Needs Plans (MA-SNP: D-SNP/C-SNP/I-SNP) (HLAEACAE)

akta.pro secondary industries

Institutional Special Needs Plans (I-SNP) (HLAEAGAB), D-SNP Plan Sponsorship & Benefit Design (HLAEAFAA), D-SNP Care Management (Medical) (HLAEAFAC), D-SNP Supplemental Benefits & Flex Card/OTC Administration (HLAEAFAN)

Keywords

• Medicare Advantage plans
• Special Needs Plans
• Health insurance services
• Medicare SNP coverage
• Senior healthcare plans

Headquarters

HQ city

Glen Allen

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Others, Marketing or Sales, Technology or R&D

Revenue model

1. Medicare Advantage Plan Premiums: Monthly premiums charged to Medicare beneficiaries enrolled in HMO I-SNP and HMO D-SNP plans. Premiums range from $0 to $36.20 per month depending on plan type and subsidy eligibility.
2. Part D Prescription Drug Coverage: Medicare Part D drug coverage included in Medicare Advantage plans, administered through Navitus pharmacy benefit manager. Revenue from prescription drug premiums and cost-sharing.
3. Supplemental Benefits Administration: Administration of supplemental benefits including dental (Liberty Dental), vision, hearing (Nations Benefits), and other value-added services for Medicare members.

Pricing tiers

Go-to-market motion3 records

Distribution channels4 records

Marketing channels4 records

Core offering

PruittHealth Premier is a Medicare Advantage Special Needs Plan (SNP) carrier that sells HMO-style Medicare Advantage insurance products (I-SNP, D-SNP, and C-SNP variants) to Medicare beneficiaries, with co-located Part D prescription drug coverage and supplemental dental, vision, hearing, and care-coordination benefits administered through vendor partners. Plans are sold to individuals residing in or eligible for long-term care, those who are dual-eligible for Medicare and Medicaid, and those diagnosed with qualifying chronic conditions such as dementia.

Product overview

PruittHealth Premier is a Medicare Advantage Special Needs Plan (SNP) organization offering three main product lines: PruittHealth Premier D-SNP (Dual-Eligible SNP) for Medicare-Medicaid beneficiaries, PruittHealth Premier HMO I-SNP for institutional long-term care eligible beneficiaries, and PruittHealth Premier Advantage HMO I-SNP at $0 premium. Sub-brands include Align Thrive (I-SNP) and Align Connect (C-SNP for dementia). The portfolio includes core Medicare Advantage plans supplemented by dental (Liberty Dental), vision, hearing (Nations Benefits), and supplemental benefits (Helper Bees). Member and provider self-service is delivered through HealthX-powered portals. Pharmacy benefits are managed through Navitus Health Solutions with a Medication Therapy Management program. Care coordination is delivered through a proprietary Model of Care program. The company operates in Georgia, North Carolina, and South Carolina, building on the broader PruittHealth community services established in 1969.

Differentiator

Problem solved

Functional benefit

Products and services

• PruittHealth Premier D-SNP (HMO D-SNP) Dual-Eligible Special Needs Plan providing Medicare Advantage coverage for individuals eligible for both Medicare and Medicaid. Includes Part D prescription drug coverage, supplemental dental, vision, and hearing benefits, and care coordination.
• PruittHealth Premier (HMO I-SNP) Institutional Special Needs Plan for Medicare beneficiaries who meet requirements for long-term care eligibility, including residents of skilled nursing, assisted living, or other long-term care facilities. Includes Part D coverage, home-based primary care, and care coordination.
• PruittHealth Premier Advantage (HMO I-SNP) Institutional Special Needs Plan variant offered at $0 monthly premium for eligible Medicare beneficiaries requiring long-term care. Bundles Part D coverage, home-based primary care, and care coordination at no monthly premium.
• Align Thrive (HMO I-SNP) Sub-brand Institutional Special Needs Plan available to Medicare beneficiaries who meet requirements for long-term care eligibility, providing the same SNP Model of Care and benefits package under a distinct brand name.
• Align Connect (HMO C-SNP) Chronic Special Needs Plan available to Medicare beneficiaries diagnosed with dementia, providing specialized care protocols, ongoing monitoring, medication management, and chronic-condition-specific support.
• Dental Benefits (Liberty Dental) Supplemental dental coverage bundled with PruittHealth Premier Medicare Advantage plans, administered through Liberty Dental, including access to a dental provider network, claims processing, and member portal for dental benefits administration.
• Hearing Benefits (Nations Benefits)

Quantifiable outcome

• Strong overall plan performance demonstrated in 2025 with goals met for Medication Review, Adult Preventive Care Visits, Understanding Daily Living Needs assessments, and Follow Up After Care Transitions.
• +2 more outcomes

Named customers3 records

Segments3 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration7 records

Feature3 records

Partnerships

Seven partnerships are on record, tiered core and minor.

• Liberty DentalcoreOthersDental benefits administrator providing claims processing and member portal access for dental coverage. Members access dental services through Liberty Dental's member portal at client.libertydentalplan.com/PruittHealthPremier. Contact: 1-866-544-1942 (TTY: 771).
• Nations BenefitscoreOthersHearing aid benefits administrator. Members log into Nations Benefits account to locate in-network providers and schedule hearing aid appointments. Contact: 888-963-5779 (TTY: 771).
• Helper BeescoreOthersMember benefits services portal for additional supplemental benefits. Members access the Helper Bees portal to view benefit overviews, check balances, and schedule services. Contact: 833-284-2438.
• Navitus Health SolutionscoreTechnology or IntegrationPharmacy benefit manager (PBM) handling prescription drug claims, formulary management, prior authorizations, step therapy, and Medication Therapy Management program. Contact: 1-866-270-3877 (TTY 711). Members access real-time benefit tools through memberportal.navitus.com.
• Curana HealthminorOthersMentioned in provider portal notes - providers directed to email [email protected] for 2023 claims and authorizations inquiries. Also handles member portal inquiries at [email protected].
• KEPROminorOthersQuality Improvement Organization contracted by CMS for independent review of appeals and reconsiderations as part of the Medicare appeal process.
• MCG (formerly Milliman Care Guidelines)coreTechnology or IntegrationEvidence-based clinical criteria provider used for medical necessity determinations when Medicare guidelines are not available. PruittHealth Premier uses MCG guidelines for utilization management decisions including inpatient reviews, prior authorizations, and retrospective reviews.

Scale indicators2 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Alignment Health: Alignment Health operates Medicare Advantage HMO plans with a strong focus on D-SNP and I-SNP products in select western states. Like PruittHealth Premier, it serves dual-eligible and institutional-eligible beneficiaries with care-coordination-led SNP models and supplemental benefits.
• American Health Advantage: American Health Advantage is a regional I-SNP-focused Medicare Advantage carrier operating in multiple states including in the Southeast. It competes directly for institutionalized beneficiaries residing in partner skilled nursing facilities, mirroring PruittHealth Premier's institutional focus.
• Lasso Healthcare Insurance Company: Lasso Healthcare is a smaller Medicare Advantage insurer that specializes in I-SNP plans for institutionalized beneficiaries in multiple states. Its SNP-only product focus and reliance on SNF partnerships make it a direct competitor for PruittHealth Premier's core I-SNP business.
• Zing Health: Zing Health is a Medicare Advantage plan that focuses heavily on D-SNP and C-SNP products serving dual-eligible and chronically ill seniors. Its SNP-led, care-coordination model and supplemental benefits approach closely parallel PruittHealth Premier's D-SNP and C-SNP strategy.

Broad incumbents

• UnitedHealthcare: UnitedHealthcare is the largest Medicare Advantage carrier nationally and a major SNP sponsor (D-SNP, I-SNP, C-SNP). Its AARP-branded MA plans compete with PruittHealth Premier across the Southeast but as a broad incumbent offering many non-SNP MA products as well.
• Centene (WellCare): Centene, through WellCare, is a leading D-SNP operator with a heavy Medicaid footprint, including in the southeastern U.S. Its dual-eligible focus overlaps with PruittHealth Premier's D-SNP business, while its broader government-insurance portfolio makes it a broad incumbent.
• Humana: Humana is the largest operator of I-SNP plans in the U.S. and a major D-SNP carrier nationwide. It competes with PruittHealth Premier for institutional and dual-eligible members across the Southeast, but its scale, national footprint, and broader MA portfolio place it as a broad incumbent rather than a direct niche peer.
• Molina Healthcare: Molina Healthcare is a government-insurance carrier with significant Medicaid and D-SNP operations across the Southeast. It competes for dual-eligible beneficiaries alongside PruittHealth Premier's D-SNP, but operates as a broad incumbent rather than a SNP specialist.

Emerging players

• Clover Health: Clover Health is a tech-enabled Medicare Advantage carrier focused on D-SNP and other MA products in select states. Its technology-driven care management and D-SNP focus make it an emerging peer competing for similar dual-eligible populations in overlapping geographies.

Others

• AllyAlign Health: AllyAlign Health is a management services organization that administers D-SNP and other SNP plans, including the interoperability infrastructure referenced under PruittHealth Premier's portal. It is a partner/administrator to PruittHealth Premier rather than a direct competitor, but is adjacent in the SNP ecosystem.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/pruitthealthpremier
• LinkedInlinkedin.com/company/pruitthealth-premier

Compliance5 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about PruittHealth Premier