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 2025, 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 2025.
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 $15.60. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $3900.00 (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 $3900.00 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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The MercyOne Health Plan Choice (PPO) has an "Enhanced Alternative" drug benefit. This plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying costs depending on the drug tier and pharmacy. For example, you will pay a $5 copay at a standard pharmacy for preferred generic drugs. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The MercyOne Health Plan Choice (PPO) plan offers a variety of benefits, including inpatient hospital stays with a $360 copay for days 1-5, and no copay for days 6-90, and outpatient services with copays ranging from $0 to $300. You'll also find coverage for emergency services with a $110 copay, primary care with no copay, and vision services with eye exams covered with a copay between $0 and $35. This plan also includes coverage for hearing exams with a $35 copay, and prescription hearing aids with a copay between $599 and $899. Dental services are covered with varying copays and coinsurance, while home health services and skilled nursing facility services have no copay for certain days. Additionally, you can expect to pay coinsurance for services like dialysis, medical equipment, and some diagnostic and radiological services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, there is a $360 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, there is a $360 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $300, observation services with no copay, ambulatory surgical center services with a $300 copay, individual and group outpatient substance abuse sessions with a $35 copay, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the MercyOne Health Plan Choice (PPO) plan. The copay for this benefit is $50.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MercyOne Health Plan Choice (PPO). This includes coverage for both ground ambulance services with a $250 copay and air ambulance services with a $300 copay, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the MercyOne Health Plan Choice (PPO) plan. Emergency Services have a $110 copay and no coinsurance; Urgently Needed Services have a $35 copay and no coinsurance; and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay and no coinsurance, while Worldwide Emergency Transportation has a $250-$300 copay and no coinsurance.
Primary Care See details
The MercyOne Health Plan Choice (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, mental health specialty services with a $35 copay, and physical therapy and speech-language pathology services with a $35 copay. The plan also covers additional telehealth benefits with a copay between $0 and $35, and opioid treatment program services with a $35 copay. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, and additional preventive services, including annual physical exams with no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, and telemonitoring services are not covered. Fitness benefits, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits have no copay.
Hearing Services See details
Hearing services include hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $599 and $899. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The MercyOne Health Plan Choice (PPO) plan covers vision services, including eye exams with a copay between $0 and $35. Eyewear is covered with no copay, but there is a combined maximum benefit of $150 per year for all eyewear, and upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $35 copay, and Other Dental Services with no copay. This plan also covers Restorative Services and Oral and Maxillofacial Surgery with a 50% coinsurance, Endodontics and Periodontics with a 70% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by MercyOne Health Plan Choice (PPO), including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the MercyOne Health Plan Choice (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies also have a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests with a $30 copay, and lab services with no copay. Diagnostic Radiological Services have a copay of at least $175, while Therapeutic Radiological Services have at least 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the MercyOne Health Plan Choice (PPO) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the MercyOne Health Plan Choice (PPO), but the plan doesn't cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for these services, but the amount is not specified in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MercyOne Health Plan Choice (PPO). There is no copay for days 1-20 and 56-100, but there is a $214 copay for days 21-55, and there is no coinsurance.
Other Services See details
The MercyOne Health Plan Choice (PPO) plan covers acupuncture with a $20 copay, and it requires prior authorization; it covers over-the-counter items with no copay, and it offers a meal benefit with no copay. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved