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Mercy Care Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Mercy Care Advantage (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Mercy Care Advantage (HMO D-SNP) in 2026, please refer to our full plan details page.
Mercy Care Advantage (HMO D-SNP) is a HMO D-SNP plan offered by Mercy Care available for enrollment in 2025 to people living in Maricopa, Pinal, and Gila Counties. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Mercy Care Advantage (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Mercy Care Advantage (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Mercy Care Advantage (HMO D-SNP).
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 Mercy Care Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.00. 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 a $615.00 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 $9250.00 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:
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Drug Coverage
The Mercy Care Advantage (HMO D-SNP) plan features a defined standard drug benefit with a $615.00 prescription drug deductible. After meeting this deductible, you enter the initial coverage phase where costs are shared until your total drug expenditures reach $2,100.00. Additionally, individuals who qualify for the low-income subsidy (LIS) can see their Part D premium reduced to $17.00. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will have no copay for covered Medicare Part D drugs. However, you may still pay a share of the costs for any excluded drugs covered under an enhanced benefit.
Additional Benefits
The Mercy Care Advantage (HMO D-SNP) offers comprehensive coverage for essential medical services, typically requiring no copay and a 20% coinsurance for outpatient care, emergency services, primary care, and diagnostic tests. Inpatient hospital stays and skilled nursing facility care are partially covered with Medicare-defined copays and coinsurance. Additionally, medical equipment, dialysis, and ambulance services are covered with no copay and a 20% coinsurance, though some services require prior authorization. For specialty care, the plan provides dental benefits up to a $5,000 annual limit and vision services up to a $300 annual limit, both featuring no copay and a 20% coinsurance. Hearing services include routine exams and up to $1,900 for prescription hearing aids every four years with no copay or coinsurance. Members also benefit from a $100 monthly allowance for over-the-counter items and chronic illness meal benefits with no copay or coinsurance.
Inpatient Hospital See details
Mercy Care Advantage (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services, which require prior authorization and charge Medicare-defined copays and coinsurance. However, additional days, non-Medicare-covered stays, and hospital upgrades are not covered.
Outpatient Services See details
Outpatient services under Mercy Care Advantage (HMO D-SNP) are covered with a 20% coinsurance and no copay, although prior authorization and a doctor referral are required. Covered benefits include outpatient hospital care, observation services, ambulatory surgical center services, outpatient substance abuse treatment, and outpatient blood services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Mercy Care Advantage (HMO D-SNP) with a 20% coinsurance and no copay. Prior authorization is required before receiving these services.
Ambulance and Transportation Services See details
Mercy Care Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, providing up to 12 one-way trips per year to plan-approved health-related locations with prior authorization, while transportation to any health-related location is not covered.
Emergency Services See details
Mercy Care Advantage (HMO D-SNP) partially covers emergency services, offering emergency and urgent care with a 20% coinsurance and no copay. However, worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Primary care benefits are covered by Mercy Care Advantage (HMO D-SNP) with a 20% coinsurance and no copay for most services, including specialist, psychiatric, and physical therapy visits. Chiropractic services are partially covered, as routine chiropractic care is not covered.
Preventive Services See details
Mercy Care Advantage (HMO D-SNP) partially covers preventive services, offering Medicare-covered zero-dollar services with no copay and no coinsurance, and kidney disease education or specific screenings with a 20% coinsurance and no copay. However, the plan does not cover annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, disease management, telemonitoring, safety devices, or counseling.
Hearing Services See details
Mercy Care Advantage (HMO D-SNP) covers annual routine hearing exams and fitting evaluations with no copay and a 20% coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,900 maximum limit every 4 years, while OTC hearing aids and inner, outer, and over-the-ear prescription models are not covered.
Vision Services See details
Mercy Care Advantage (HMO D-SNP) partially covers vision services, offering one routine eye exam per year and select eyewear with no copay and 20% coinsurance. Covered eyewear is subject to a combined annual limit of $300, but standalone eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Mercy Care Advantage (HMO D-SNP), with Medicare-covered dental services requiring no copay and a 20% coinsurance. Preventive and comprehensive benefits are covered up to a $5,000 annual limit, but maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Mercy Care Advantage (HMO D-SNP) covers Home Infusion bundled Services with prior authorization, including Medicare Part B Insulin Drugs for a $35 copay and no coinsurance to 20% coinsurance. Other covered Part B chemotherapy, radiation, and miscellaneous drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Mercy Care Advantage (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Mercy Care Advantage (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with a 20% coinsurance and no copay. Prior authorization is required for durable medical equipment and prosthetic devices.
Diagnostic and Radiological Services See details
Mercy Care Advantage (HMO D-SNP) covers diagnostic and radiological services, including lab tests, therapeutic radiology, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required for all of these covered services.
Home Health Services See details
Home health services are covered under Mercy Care Advantage (HMO D-SNP), though prior authorization is required before receiving these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Mercy Care Advantage (HMO D-SNP), as Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are all not covered. Because these services are not covered, there is no plan copay or coinsurance available.
Skilled Nursing Facility (SNF) See details
Mercy Care Advantage (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization and applying Medicare-defined copays and coinsurance. While admission does not require a prior three-day inpatient hospital stay, additional days beyond Medicare-covered limits are not covered.
Other Services See details
Other Services are partially covered by Mercy Care Advantage (HMO D-SNP), featuring a $100 monthly allowance for over-the-counter items and meal benefits for chronic illnesses with no copay or coinsurance. Acupuncture and highly integrated dual-eligible SNP services are not covered under this plan.
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