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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 2025, 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 2025.
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 $4500.00 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) plan offers a variety of benefits, including inpatient hospital stays with a copay, outpatient services with copays ranging from $0 to $275, and ambulance services with copays. Emergency services, vision, hearing, and dental services are also covered, with varying copays and coinsurance depending on the specific service. Preventive services, home health services, and many other services are covered with no copay. The plan includes coverage for diagnostic and radiological services, medical equipment, and skilled nursing facility stays, with specific copays and coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $250 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes 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 both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the MercyOne Health Plan Glory No RX (HMO) with a $40 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the MercyOne Health Plan Glory No RX (HMO) plan. Ground Ambulance Services have a $200 copay, while Air Ambulance Services have a $250 copay, and there is no coinsurance for either service. 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 Glory No RX (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Worldwide Emergency Transportation has a copay between $200 and $250. Urgently Needed Services have a $25 copay. There is no coinsurance for any of these services.
Primary Care See details
The MercyOne Health Plan Glory No RX (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, and physician specialist services with a $25 copay. Mental health and psychiatric individual and group sessions have a $20 copay, physical therapy and speech-language pathology services have a $25 copay, and telehealth services have a copay between $0 and $25. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, 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 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 services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $25 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a copay between $399 and $699, depending on the type of hearing aid. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$25, and eyewear, with no copay, with a combined maximum plan benefit of $200 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
Dental Services include coverage for Medicare dental services with a $25 copay and other dental services with no copay. Restorative Services and Oral and Maxillofacial Surgery have a 50% coinsurance, while Endodontics and Periodontics have a 70% coinsurance. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the MercyOne Health Plan Glory No RX (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the MercyOne Health Plan Glory No RX (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance with no copay, and medical supplies have a 20% coinsurance with no copay. Diabetic supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a $20 copay, and lab services with no copay. Radiological Services include coverage for diagnostic radiological services with a copay of at most $150, therapeutic radiological services with at least 20% coinsurance, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is a copay for some Cardiac and Pulmonary Rehabilitation Services, but the specific cost is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MercyOne Health Plan Glory No RX (HMO). There is no copay for days 1-20 and days 56-100, and a $214 copay for days 21-55.
Other Services See details
The MercyOne Health Plan Glory No RX (HMO) plan covers acupuncture with a $20 copay, over-the-counter items with no copay, and a meal benefit with no copay. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, and other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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