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MercyOne Health Plan Glory No RX (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MercyOne Health Plan Glory No RX (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 Glory No RX (HMO) in 2026, please refer to our full plan details page.
MercyOne Health Plan Glory No RX (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 Glory No RX (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about MercyOne Health Plan Glory No RX (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 Glory No RX (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 $100.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5900.00 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 Glory No RX (HMO)
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Drug Coverage
Prescription drugs are not covered by MercyOne Health Plan Glory No RX (HMO).
Additional Benefits
The MercyOne Health Plan Glory No RX (HMO) offers comprehensive medical coverage with no coinsurance for many core services, helping you manage your healthcare costs. Beneficiaries benefit from no copay for primary care doctor visits, routine preventive care, and home health services, while specialist visits require a $25 copay. For hospital stays, inpatient care requires a $350 daily copay for the first five days and no copay for days 6 through 90, while outpatient services range from no copay to a $325 copay. This plan also includes routine dental, vision, and hearing benefits, featuring no copay for annual eye exams and preventive dental care up to a $1,000 annual limit. While prescription hearing aids and comprehensive dental services require additional cost-sharing, diagnostic lab services and home infusion are covered with no copay. Additionally, durable medical equipment and dialysis services require a 20% coinsurance, while skilled nursing facility stays have no copay for the first 20 days.
Inpatient Hospital See details
MercyOne Health Plan Glory No RX (HMO) covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional days are covered for acute stays, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
MercyOne Health Plan Glory No RX (HMO) covers outpatient hospital services with no coinsurance and copays ranging from no copay to $325, or $340 per stay for observation services, and ambulatory surgical center services with a $325 copay and no coinsurance. Outpatient substance abuse services require a $20 copay per session with no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
MercyOne Health Plan Glory No RX (HMO) covers partial hospitalization services with a $40.00 copay and no coinsurance.
Ambulance and Transportation Services See details
MercyOne Health Plan Glory No RX (HMO) covers ground ambulance services with a $200 copay and air ambulance services with a $250 copay, with no coinsurance required for either service. Prior authorization is required for ambulance services, and transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
MercyOne Health Plan Glory No RX (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if admitted to the hospital within 48 hours. Urgently needed services require a $45 copay and no coinsurance, while worldwide emergency and urgent care are covered with a $130 copay and no coinsurance, and worldwide emergency transportation has a copay of $200 to $250 and no coinsurance.
Primary Care See details
MercyOne Health Plan Glory No RX (HMO) covers primary care physician services with no copay and no coinsurance, and specialist, physical therapy, and occupational therapy visits with a $25 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services require a $20 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
MercyOne Health Plan Glory No RX (HMO) offers preventive services with no copay and no coinsurance for covered benefits, including annual physical exams, kidney disease education, glaucoma screenings, diabetes training, and fitness benefits. This benefit is partially covered as it excludes several supplemental services such as health education, in-home safety assessments, personal emergency response systems, and weight management programs.
Hearing Services See details
MercyOne Health Plan Glory No RX (HMO) covers hearing exams and fitting evaluations with no coinsurance and either a $25 copay for Medicare-covered exams or no copay for routine visits. Prescription hearing aids are partially covered with no coinsurance and a copay of $399 to $699 for up to two devices per year, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by MercyOne Health Plan Glory No RX (HMO), offering one routine eye exam per year and covered eyewear up to a $200 annual limit with no copay and no coinsurance. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
MercyOne Health Plan Glory No RX (HMO) partially covers dental services, excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $25 copay and no coinsurance, preventive services have no copay and no coinsurance up to a $1,000 annual limit, and covered comprehensive services require no copay and 50% to 70% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by MercyOne Health Plan Glory No RX (HMO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by MercyOne Health Plan Glory No RX (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
MercyOne Health Plan Glory No RX (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes or inserts require 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by MercyOne Health Plan Glory No RX (HMO), offering lab services with no copay and no coinsurance, and outpatient X-rays with no copay. Diagnostic procedures and tests require a $20 copay with no coinsurance, while diagnostic radiological services require a minimum $200 copay and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
MercyOne Health Plan Glory No RX (HMO) covers Home Health Services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
MercyOne Health Plan Glory No RX (HMO) offers cardiac rehabilitation services with no coinsurance, although only some services are covered. Standard cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services ($15 copay) are not covered.
Skilled Nursing Facility (SNF) See details
MercyOne Health Plan Glory No RX (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day hospital stay. You pay no copay for days 1 to 20 and days 61 to 100, and a $218 daily copay for days 21 to 60, with no coverage for additional days beyond the standard 100-day limit.
Other Services See details
MercyOne Health Plan Glory No RX (HMO) covers acupuncture with a $20 copay and no coinsurance for up to 12 treatments per year, which requires prior authorization. Over-the-counter items up to $50 every three months and meal benefits for chronic illnesses are also covered 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
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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.
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