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MercyOne Health Plan Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MercyOne Health Plan Plus (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 Plus (HMO) in 2026, please refer to our full plan details page.
MercyOne Health Plan Plus (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 Plus (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 Plus (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 Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $22.80. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $100.00 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 $3900.00 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 Plus (HMO)
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Drug Coverage
The MercyOne Health Plan Plus (HMO) prescription drug benefit features a $100 annual drug deductible. Beneficiaries enjoy savings on generic medications, with no copay required for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs for up to a three-month supply at standard pharmacies or through standard mail order. For brand-name and specialty medications, costs are based on a coinsurance percentage rather than a flat copayment. You will pay 25% coinsurance for Tier 3 (Preferred Brand) drugs, 40% coinsurance for Tier 4 (Non-Preferred) drugs, and 31% coinsurance for a one-month supply of Tier 5 (Specialty) drugs.
Additional Benefits
MercyOne Health Plan Plus (HMO) offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits and home health services. Specialist visits require a $25 copay, while inpatient hospital stays incur a $300 daily copay for the first five days and no copay for days six through 90. Emergency room visits have a $150 copay, which is waived if you are admitted, and urgent care services are available with a $30 copay. The plan also includes valuable supplemental benefits like preventive dental care, routine hearing exams, and routine eye exams with no copay or coinsurance. Members can take advantage of a $250 annual allowance for eyewear, prescription hearing aid coverage with copays ranging from $599 to $899, and a $75 quarterly over-the-counter allowance. These additional benefits help manage your health expenses by offering extensive coverage with minimal out-of-pocket costs.
Inpatient Hospital See details
MercyOne Health Plan Plus (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
MercyOne Health Plan Plus (HMO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $300 for outpatient hospital services and $290 per stay for observation services. Ambulatory surgical center services carry a $300 copay with no coinsurance, while outpatient substance abuse sessions require a $20 copay and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
MercyOne Health Plan Plus (HMO) covers partial hospitalization services with a $45.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by MercyOne Health Plan Plus (HMO), with ground ambulance services requiring a $220 copay and air ambulance services requiring a $270 copay, both with no coinsurance. Prior authorization is required for all ambulance services, and transportation services are not covered.
Emergency Services See details
MercyOne Health Plan Plus (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services are covered with a $30 copay and no coinsurance, while worldwide emergency services feature no coinsurance and copays of $150 for emergency or urgent care and $220 to $270 for emergency transportation.
Primary Care See details
MercyOne Health Plan Plus (HMO) covers primary care visits with no copay and no coinsurance, and specialist, physical, and occupational therapy with a $25 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services require a $20 copay and no coinsurance, while podiatry is not covered. For chiropractic services, some services are covered with a $20 copay and no coinsurance, but routine and other chiropractic services are not covered.
Preventive Services See details
MercyOne Health Plan Plus (HMO) offers partially covered preventive services with no copay and no coinsurance for annual physicals, fitness benefits, remote access technologies, and select screenings. Several supplemental benefits are not covered, including health education, weight management, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
MercyOne Health Plan Plus (HMO) covers Medicare-covered hearing exams with a $25 copay and no coinsurance, while routine hearing exams and fitting evaluations are fully covered with no 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, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
MercyOne Health Plan Plus (HMO) offers partially covered vision services with no deductible and no coinsurance, featuring a $0 to $25 copay for eye exams and no copay for eyewear up to a $250 annual limit. Covered services include one routine eye exam per year and eyeglasses or contact lenses, while other eye exam services and eyewear upgrades are not covered.
Dental Services See details
MercyOne Health Plan Plus (HMO) partially covers dental services, offering preventive care with no copay and no coinsurance up to a $1,000 annual maximum, and Medicare-covered dental with a $25 copay and no coinsurance. Comprehensive benefits like restorative treatment and oral surgery are covered with no copay and 50% to 70% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by MercyOne Health Plan Plus (HMO) with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the MercyOne Health Plan Plus (HMO) with no copay and a 20% coinsurance. This coverage helps you clearly understand your out-of-pocket costs for necessary dialysis treatments.
Medical Equipment See details
Medical equipment is covered by MercyOne Health Plan Plus (HMO), with prior authorization required for all services. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are covered with no copay and a 20% coinsurance, while diabetic supplies from specified manufacturers feature no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by MercyOne Health Plan Plus (HMO), featuring no coinsurance and a $20 copay for diagnostic procedures, while lab services and outpatient X-rays are available with no copay. Diagnostic radiological services require a $195 copay, and therapeutic radiological services incur a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by MercyOne Health Plan Plus (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
MercyOne Health Plan Plus (HMO) covers some cardiac rehabilitation services with no copay and no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
MercyOne Health Plan Plus (HMO) covers skilled nursing facility (SNF) services with no coinsurance and does not require a prior three-day hospital stay. There is no copay for days 1 to 20 and days 61 to 100, but a $218 daily copay applies for days 21 to 60, with no coverage for additional days beyond the 100-day Medicare limit.
Other Services See details
MercyOne Health Plan Plus (HMO) provides partial coverage for other services, featuring acupuncture for a $20 copay and no coinsurance, alongside meal benefits and a $75 quarterly over-the-counter allowance with no copay and no coinsurance. Other sub-services, including Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services, are not covered.
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