A non-government entity
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 2025, 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 2025.
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 $16.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 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)
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 Plus (HMO) has a $0 deductible for prescription drugs. In the initial coverage phase, you may pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at standard or mail order pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. This plan may have a reduced premium if you qualify for the low-income subsidy, which is $16.00.
Additional Benefits
The MercyOne Health Plan Plus (HMO) offers a range of benefits with varying costs. Inpatient hospital stays have a $300 copay for the first five days, and then no copay for the rest of the stay, while outpatient services have copays ranging from $0 to $275. The plan also includes coverage for services like primary care with no copay, hearing and vision services with copays, and dental services with coinsurance for certain procedures.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $300 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, there is a $300 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services with a copay between $0 and $275, observation services with no copay, ambulatory surgical center services with a $275 copay, outpatient substance abuse services with a $20 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the MercyOne Health Plan Plus (HMO) with a $45 copay. There is no coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MercyOne Health Plan Plus (HMO). Ground Ambulance Services have a $220 copay, and Air Ambulance Services have a $270 copay, but there is no coinsurance. 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 by the MercyOne Health Plan Plus (HMO). Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $25 copay, and Worldwide Emergency Transportation has a copay between $220 and $270; there is no coinsurance for any of these services.
Primary Care See details
The MercyOne Health Plan Plus (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay (routine care not covered), occupational therapy with a $25 copay, and specialist visits with a $25 copay. Mental health and psychiatric individual and group sessions have a $20 copay, and physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits have a copay ranging from $0 to $25.
Preventive Services See details
The MercyOne Health Plan Plus (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, and other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams, including services not usually covered by Medicare, have a $25 copay. Routine hearing exams are covered with no copay for one visit every year, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids (all types) are covered with a copay between $599 and $899 for two hearing aids every year, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The MercyOne Health Plan Plus (HMO) plan covers vision services, including eye exams with a copay of $0-$25, and eyewear with a combined maximum of $250 per year. Routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, while upgrades are not covered.
Dental Services See details
The MercyOne Health Plan Plus (HMO) plan covers dental services, including Medicare Dental Services with a $25 copay, and Other Dental Services with no copay. Restorative Services and Oral and Maxillofacial Surgery have 50% coinsurance, while Endodontics and Periodontics have 70% coinsurance. Other dental services such as Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the MercyOne Health Plan Plus (HMO) plan. You will pay 20% coinsurance.
Medical Equipment See details
The MercyOne Health Plan Plus (HMO) plan covers medical equipment, including Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is also covered, with specific coinsurance and copay amounts that vary depending on the service, and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the MercyOne Health Plan Plus (HMO). Diagnostic Procedures/Tests have a $20 copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at least $150, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the MercyOne Health Plan Plus (HMO) with no copay and no coinsurance, but 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 Plus (HMO), but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for these services, but the specific amount is not provided in the snippet.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the MercyOne Health Plan Plus (HMO). There is no copay for days 1-20 and days 56-100, but there is a $214 copay for days 21-55.
Other Services See details
Under the MercyOne Health Plan Plus (HMO), acupuncture has a $20 copay, and over-the-counter items have no copay and are limited to $110 every three months. The plan also covers a meal benefit with no copay. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, and several other services 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