A non-government entity
MercyOne Health Plan No Premium (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MercyOne Health Plan No Premium (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MercyOne Health Plan No Premium (HMO) in 2026, please refer to our full plan details page.
MercyOne Health Plan No Premium (HMO) is a HMO 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 4.5 out of 5 stars in 2026.
It's important to know that MercyOne Health Plan No Premium (HMO) 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 No Premium (HMO).
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 No Premium (HMO), 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 $0.30. 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 $150.00 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 Maximum Out-Of-Pocket cost of $4200.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 No Premium (HMO)
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 No Premium (HMO) features an annual drug deductible of $150. For Tier 1 preferred generic and Tier 2 generic drugs, members enjoy no copay for one-month, two-month, and three-month supplies filled at standard pharmacies or through standard mail order. This cost-saving benefit helps keep everyday prescription medications highly affordable. For higher-tier medications, cost-sharing is based on coinsurance rather than set copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 50% coinsurance for standard pharmacy and mail order fills. Tier 5 specialty drugs have a 31% coinsurance for a one-month supply.
Additional Benefits
The MercyOne Health Plan No Premium (HMO) offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For inpatient hospital stays, members pay a $325 daily copay for the first five days and no copay for days six through 90, while emergency room visits carry a $110 copay. Specialized care, including specialist visits and physical therapy, is highly accessible with a predictable $30 copay and no coinsurance. This plan also features robust supplemental benefits, including routine dental, vision, and hearing exams with no copay and no coinsurance, alongside a $200 annual allowance for eyewear and a $1,000 annual limit for preventive dental care. High-cost needs like durable medical equipment and dialysis require a 20% coinsurance and no copay, while Medicare Part B insulin is capped at a $35 copay. Additionally, members can access acupuncture for a $20 copay, alongside over-the-counter items and chronic illness meals with no copay.
Inpatient Hospital See details
MercyOne Health Plan No Premium (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 5 and no copay for days 6 through 90. Additional acute stay days are covered with no copay, but room upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by MercyOne Health Plan No Premium (HMO) with no coinsurance, featuring copays ranging from no copay to $275 for hospital services and $315 per stay for observation services. Ambulatory surgical center services have a $275 copay, outpatient substance abuse sessions have a $30 copay, and blood services require no copay, all with no coinsurance.
Partial Hospitalization See details
MercyOne Health Plan No Premium (HMO) covers partial hospitalization services with a $50.00 copay and no coinsurance. This benefit ensures you have access to necessary outpatient care with clear, predictable out-of-pocket costs.
Ambulance and Transportation Services See details
MercyOne Health Plan No Premium (HMO) covers ambulance services with no coinsurance, requiring a $240 copay for ground transport and a $290 copay for air transport, both of which require prior authorization. Transportation services to health-related locations are not covered.
Emergency Services See details
MercyOne Health Plan No Premium (HMO) 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 $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $110 to $290.
Primary Care See details
MercyOne Health Plan No Premium (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical, occupational, and speech therapies, and mental health services require a $30 copay and no coinsurance. Telehealth benefits feature a $0 to $30 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
MercyOne Health Plan No Premium (HMO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are only partially covered, offering fitness benefits and remote access technologies with no copay and no coinsurance, while health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, safety modifications, and counseling are not covered.
Hearing Services See details
MercyOne Health Plan No Premium (HMO) covers hearing services with no deductible, offering routine exams and fitting evaluations for no copay and no coinsurance, while Medicare-covered exams require a $30 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a $599 to $899 copay for up to two devices per year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
MercyOne Health Plan No Premium (HMO) partially covers vision services with no deductibles and no coinsurance, providing no copay for one annual routine eye exam and eyewear up to a $200 yearly limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
MercyOne Health Plan No Premium (HMO) offers partially covered dental services, which exclude maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental requires a $30 copay and no coinsurance, preventive services are available with no copay and no coinsurance up to a $1,000 yearly maximum, and other covered comprehensive services require no copay and 50% to 70% coinsurance.
Home Infusion bundled Services See details
MercyOne Health Plan No Premium (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs are covered with no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the MercyOne Health Plan No Premium (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
MercyOne Health Plan No Premium (HMO) covers durable medical equipment (DME), prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes or inserts require a 20% coinsurance, with coverage limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the MercyOne Health Plan No Premium (HMO), featuring no coinsurance for diagnostic services, a $30 copay for diagnostic procedures, and no copay for lab services. For radiological services, outpatient X-rays require no copay, diagnostic radiological services have a copay starting at $160, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
MercyOne Health Plan No Premium (HMO) provides coverage for home health services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
MercyOne Health Plan No Premium (HMO) does not cover Cardiac Rehabilitation Services, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are all not covered.
Skilled Nursing Facility (SNF) See details
MercyOne Health Plan No Premium (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring 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 hospital stay is not required for admission, but additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
MercyOne Health Plan No Premium (HMO) partially covers other services, excluding Other 1, Other 2, and Other 3. Covered benefits include acupuncture with a $20.00 copay and no coinsurance, as well as over-the-counter items and chronic illness meal benefits with no copay and no coinsurance.
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