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MercyOne Health Plan Cash Back (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MercyOne Health Plan Cash Back (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 Cash Back (HMO) in 2026, please refer to our full plan details page.
MercyOne Health Plan Cash Back (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 Cash Back (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 Cash Back (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 Cash Back (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 $102.40. 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 $250.00 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 $6900.00 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 Cash Back (HMO)
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Drug Coverage
The MercyOne Health Plan Cash Back (HMO) features a $250 drug deductible for its prescription drug coverage. Under this plan, you will pay no copay for Tier 1 preferred generic drugs at standard pharmacies and through standard mail order. For Tier 2 generic drugs, you pay no copay when using standard mail order, while standard retail pharmacy copays range from $5 for a one-month supply to $15 for a three-month supply. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, and Tier 4 non-preferred drugs require a 35% coinsurance at standard pharmacies and through mail order. Tier 5 specialty drugs carry a 30% coinsurance for a one-month supply through standard pharmacies or standard mail order.
Additional Benefits
The MercyOne Health Plan Cash Back (HMO) offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, home health services, and preventive care. For specialized treatment, members pay a $40 copay for specialist visits, while inpatient hospital stays require a daily copay of $450 for the first five days of acute care with no coinsurance. Emergency room visits are covered with a $115 copay, which is waived if you are admitted within 48 hours, and urgent care services require a $40 copay. Routine vision exams, eyewear up to $150, and preventive dental cleanings are covered with no copay, though restorative dental services require a 50% coinsurance. Durable medical equipment and dialysis services are available with no copay, though a 20% coinsurance applies to both. Members also benefit from no-copay skilled nursing facility stays for the first 20 days and over-the-counter items with no copay up to a $25 quarterly limit.
Inpatient Hospital See details
MercyOne Health Plan Cash Back (HMO) covers inpatient hospital services with no coinsurance, requiring a $450 daily copay for days 1 to 5 of acute stays and a $415 daily copay for days 1 to 5 of psychiatric stays. There is no copay for additional acute days or days 6 to 90 of psychiatric stays, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by MercyOne Health Plan Cash Back (HMO) with no coinsurance, featuring copays ranging from $10.00 to $425.00 for outpatient hospital services and a $405.00 copay per stay for observation services. Ambulatory surgical center services require a $425.00 copay (no coinsurance), outpatient substance abuse sessions have a $40.00 copay (no coinsurance), and outpatient blood services are provided with no copay, coinsurance, or deductible.
Partial Hospitalization See details
MercyOne Health Plan Cash Back (HMO) covers partial hospitalization services with a $60.00 copay and no coinsurance.
Ambulance and Transportation Services See details
MercyOne Health Plan Cash Back (HMO) covers ambulance services with prior authorization, requiring no coinsurance and a copay of $275 for ground transport and $325 for air transport. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
MercyOne Health Plan Cash Back (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays ranging from $115 to $325.
Primary Care See details
Primary care benefits under the MercyOne Health Plan Cash Back (HMO) feature no copay and no coinsurance for primary care physician visits, alongside telehealth services ranging from no copay to a $40 copay with no coinsurance. Specialist visits, mental health, psychiatric, and opioid treatment services require a $40 copay, while physical, occupational, and speech therapies have a $35 copay, all with no coinsurance; however, podiatry and chiropractic services are not covered.
Preventive Services See details
MercyOne Health Plan Cash Back (HMO) covers preventive services, including annual physicals, kidney disease education, and fitness benefits, with no copay and no coinsurance. However, these additional benefits are only partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, 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, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by MercyOne Health Plan Cash Back (HMO), offering Medicare-covered exams for a $40 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with a $599 to $899 copay and no coinsurance, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the MercyOne Health Plan Cash Back (HMO), featuring no deductibles and no coinsurance. Routine eye exams and eyewear (up to a $150 annual limit) have no copay, while other eye exams have a copay of up to $40.00; however, upgrades and other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by the MercyOne Health Plan Cash Back (HMO), offering Medicare dental services for a $40 copay and no coinsurance, and preventive services like cleanings and exams for no copay and no coinsurance up to a $1,000 annual limit. Restorative and oral surgery services require no copay and a 50% coinsurance, while other preventive services, endodontics, periodontics, prosthodontics, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by MercyOne Health Plan Cash Back (HMO) with no copay, though prior authorization is required. Under this benefit, Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the MercyOne Health Plan Cash Back (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by MercyOne Health Plan Cash Back (HMO) with no copays, though a 20% coinsurance applies to durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies are also covered with no copay, and prior authorization is required for most of these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the MercyOne Health Plan Cash Back (HMO) with no coinsurance for diagnostic services, a $10 copay for lab services, and a $50 copay for diagnostic tests. Diagnostic radiological services require a minimum $395 copay, outpatient X-rays have a $20 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by the MercyOne Health Plan Cash Back (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the MercyOne Health Plan Cash Back (HMO) with no coinsurance, although some services are not covered. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, while other covered services require copayments between $15 and $30.
Skilled Nursing Facility (SNF) See details
MercyOne Health Plan Cash Back (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and days 61 to 100, and a $218 daily copay for days 21 to 60. A three-day prior inpatient hospital stay is not required for admission, but additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
MercyOne Health Plan Cash Back (HMO) covers acupuncture services with a $20 copay and no coinsurance, limited to 6 treatments per year with prior authorization required. Over-the-counter (OTC) items and chronic illness meal benefits are also covered with no copay and no coinsurance, with OTC items limited to a maximum of $25 every three months.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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