A non-government entity
MercyOne Health Plan Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MercyOne Health Plan Choice (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MercyOne Health Plan Choice (PPO) in 2026, please refer to our full plan details page.
MercyOne Health Plan Choice (PPO) is a PPO plan offered by Trinity Health Corporation available for enrollment in 2025 to people living in Select Counties in Iowa. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that MercyOne Health Plan Choice (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about MercyOne Health Plan Choice (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For MercyOne Health Plan Choice (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.70. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $4400.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $4400.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for MercyOne Health Plan Choice (PPO)
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Drug Coverage
The MercyOne Health Plan Choice (PPO) prescription drug coverage includes a $200 annual drug deductible. Tier 1 preferred generic drugs feature no copay for one, two, or three-month supplies at standard pharmacies and through standard mail order. Tier 2 generic drugs have a $5 copay for a one-month supply at standard pharmacies, but they offer no copay when ordered through standard mail order. For brand name and specialty medications, costs are determined by coinsurance. Tier 3 preferred brand drugs carry a 25% coinsurance, and Tier 4 non-preferred drugs require a 40% coinsurance at both standard pharmacies and mail-order services. Tier 5 specialty drugs are available only in one-month supplies and carry a 30% coinsurance.
Additional Benefits
MercyOne Health Plan Choice (PPO) offers comprehensive medical coverage with no copay for primary care visits, annual preventive services, and routine lab tests. Specialized care, including specialist visits, physical therapy, and urgent care, requires a $35 copay with no coinsurance. For hospital stays, inpatient care features a $360 daily copay for the first five days and no copay thereafter, while outpatient hospital services range from no copay up to a $300 copay. The plan also features strong supplemental benefits, including no copay for annual routine vision and hearing exams, alongside preventive dental care up to a $1,000 annual limit. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay, while prescription hearing aids carry a copay ranging from $599 to $899. Additionally, members can take advantage of a $75 quarterly allowance with no copay for over-the-counter products.
Inpatient Hospital See details
MercyOne Health Plan Choice (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $360 daily copay for days 1 to 5 and no copay for days 6 to 90. Unlimited additional days are covered with no copay for acute care, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
MercyOne Health Plan Choice (PPO) covers outpatient hospital services with a $0 to $300 copay and observation services with a $350 copay per stay, both with no coinsurance. Ambulatory surgical center services require a $300 copay, outpatient substance abuse sessions have a $35 copay, and outpatient blood services have no copay, all with no coinsurance.
Partial Hospitalization See details
MercyOne Health Plan Choice (PPO) covers partial hospitalization services with a $50.00 copay and no coinsurance.
Ambulance and Transportation Services See details
MercyOne Health Plan Choice (PPO) covers ground ambulance services with a $250 copay and air ambulance services with a $300 copay, both requiring prior authorization and featuring no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
MercyOne Health Plan Choice (PPO) covers emergency services with a $110 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services require a $35 copay and no coinsurance, while worldwide emergency care features a $110 copay and emergency transportation ranges from a $250 to $300 copay, both with no coinsurance.
Primary Care See details
Primary care services under the MercyOne Health Plan Choice (PPO) are covered with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and mental health services require a $35 copay and no coinsurance. Telehealth benefits range from no copay to a $35 copay with no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
MercyOne Health Plan Choice (PPO) offers partial coverage for preventive services, with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, EKGs, fitness benefits, and remote access technologies. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by MercyOne Health Plan Choice (PPO), offering routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $35 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $599 to $899 for up to two aids per year, though inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
MercyOne Health Plan Choice (PPO) partially covers vision services with no deductibles or coinsurance, offering one routine eye exam per year with no copay and covered eyewear up to a $150 annual maximum with no copay. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
MercyOne Health Plan Choice (PPO) partially covers dental services, excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $35 copay and no coinsurance, while preventive care is available with no copay or coinsurance up to a $1,000 annual limit. Other covered comprehensive services have no copay and coinsurance ranging from 0% to 70% depending on the procedure.
Home Infusion bundled Services See details
MercyOne Health Plan Choice (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and a 0% to 20% coinsurance.
Dialysis Services See details
MercyOne Health Plan Choice (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
MercyOne Health Plan Choice (PPO) covers durable medical equipment (DME), prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
MercyOne Health Plan Choice (PPO) covers diagnostic services with no coinsurance, requiring a $30 copay for diagnostic procedures and no copay for lab services, though prior authorization is required. Covered radiological services include outpatient X-rays with no copay, diagnostic radiological services with a $175 copay, and therapeutic radiological services with a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by MercyOne Health Plan Choice (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
MercyOne Health Plan Choice (PPO) provides coverage for cardiac rehabilitation services with no copay and no coinsurance. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered in practice.
Skilled Nursing Facility (SNF) See details
MercyOne Health Plan Choice (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and days 61 to 100, and a $218 daily copay for days 21 to 60. A prior three-day inpatient hospital stay is not required for admission, though additional days beyond the standard 100-day Medicare benefit period are not covered.
Other Services See details
MercyOne Health Plan Choice (PPO) covers other services including acupuncture for a $20 copay and no coinsurance, limited to 6 treatments per year with prior authorization. Over-the-counter items and meal benefits for chronic illnesses are also covered with no copay and no coinsurance, including up to $75 every three months for over-the-counter products.
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