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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 2025, 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 2.5 out of 5 stars in 2025.
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 $30.10. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.30. 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 $590.00 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 $9350.00 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 has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. This plan's premium may be reduced if you qualify for the low-income subsidy, and the monthly premium is $30.10 if you qualify for the LIS.
Additional Benefits
The Mercy Care Advantage (HMO D-SNP) plan offers coverage for a wide range of services, including inpatient and outpatient care, with varying cost-sharing. You'll pay a copay of $1630 per admission for inpatient hospital stays, and most outpatient services have a 20% coinsurance. The plan also provides coverage for ambulance services with no copay, and transportation to health-related locations. This plan includes benefits for primary care, preventive services, hearing, vision, and dental care, with different cost-sharing structures. Hearing exams have a coinsurance of at most 20%, and fitting/evaluation for hearing aids has no coinsurance. The plan also covers home health services with no copay. Additionally, this plan covers OTC items up to $100 per month and offers a meal benefit for chronic illness.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered under the Mercy Care Advantage (HMO D-SNP) plan, each with a copay of $1630.00 per admission or stay. Additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient substance abuse services have a coinsurance of 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by Mercy Care Advantage (HMO D-SNP), but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Mercy Care Advantage (HMO D-SNP) plan, with no copay for ambulance services. Ground and air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 42 one-way trips per year, and transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered with a 20% coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under this plan. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Other Health Care Professional have a 20% coinsurance. Occupational Therapy Services, Individual and Group Sessions for Mental Health Specialty Services, Routine Foot Care, Individual and Group Sessions for Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Routine Chiropractic Care is limited to 12 visits per year.
Preventive Services See details
Preventive services include Medicare-covered services with no copay, while annual physical exams are not covered. Additional preventive services are covered, including health education, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, a fitness benefit, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs. Kidney disease education services have a 20% coinsurance, while other preventive services have a coinsurance for Medicare-covered barium enemas.
Hearing Services See details
Hearing services include routine hearing exams with a coinsurance of at most 20%, and fitting/evaluation for hearing aids with no coinsurance. Prescription hearing aids are covered up to a maximum of $1900 every two years, but inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a 20% coinsurance, and eyewear with a 20% coinsurance and a combined maximum of $300.00 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Mercy Care Advantage (HMO D-SNP) plan covers dental services, including Medicare Dental Services with 20% coinsurance. The plan also covers Oral Exams (1 every six months), Dental X-Rays (1 per year), Prophylaxis (Cleaning) (1 every six months), Fluoride Treatment (1 every six months), Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), and Oral and Maxillofacial Surgery. Orthodontic Services are covered up to a maximum of $5,000 per year. The plan does not cover Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Mercy Care Advantage (HMO D-SNP) plan, but require prior authorization. For Medicare Part B insulin drugs, there is a $35 copay, and a coinsurance between 0% and 20%. For Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Mercy Care Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by Mercy Care Advantage (HMO D-SNP), including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with authorization required, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Mercy Care Advantage (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Mercy Care Advantage (HMO D-SNP) plan with no copay and no coinsurance, but prior authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Mercy Care Advantage (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, though prior authorization is required. The plan does not cover additional days beyond Medicare-covered SNF services or non-Medicare-covered SNF stays, and the cost sharing is the same as original Medicare.
Other Services See details
The Mercy Care Advantage (HMO D-SNP) plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. Over-the-Counter (OTC) Items are covered up to $100 per month. The plan also covers a meal benefit for chronic illness with prior authorization.
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