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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, Gila, Pinal, and Pima 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.
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 $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 $2000.00. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS), which is also known as "Extra Help". The plan provides catastrophic coverage after your yearly out-of-pocket drug costs reach $2000, where you pay nothing for covered drugs.
Additional Benefits
The Mercy Care Advantage (HMO D-SNP) plan offers a range of services with varying cost-sharing. Inpatient hospital stays have a $1,630 copay per admission, while many outpatient services and primary care visits require a 20% coinsurance. The plan also includes benefits for hearing, vision, and dental care, with coinsurance and specific limits on coverage. Additional benefits include transportation, home health services with no cost sharing, and coverage for medical equipment and supplies with a 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a copay of $1,630 per admission or stay. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services cover outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services. Outpatient hospital services and observation services have a 20% coinsurance, while individual and group sessions for outpatient substance abuse have a coinsurance between 20% and 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, 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. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location are covered for up to 42 one-way trips per year, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by Mercy Care Advantage (HMO D-SNP) with a 20% coinsurance, and 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
The Mercy Care Advantage (HMO D-SNP) plan covers 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. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, have a 20% coinsurance. Occupational Therapy Services, Mental Health Specialty Services, and Psychiatric Services have a 20% coinsurance. Podiatry Services and Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
The Mercy Care Advantage (HMO D-SNP) plan covers preventive services, including Medicare-covered services with no copay, and additional preventive services like health education, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. However, annual physical exams, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), 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, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. Kidney disease education services and diabetes self-management training have a 20% coinsurance, and barium enemas have a coinsurance.
Hearing Services See details
Hearing exams are covered with at most 20% coinsurance, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered up to $1900 every two years, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are limited to 1 per year. Eyewear, including contact lenses, has a 20% coinsurance and a combined maximum benefit of $300 per year, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other Dental Services include coverage for oral exams (1 visit every six months), dental x-rays (1 visit per year), prophylaxis (cleaning) (1 visit every six months), fluoride treatment (1 visit every six months), and oral and maxillofacial surgery. Orthodontic services are covered up to a maximum of $5,000 per year. Restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics (removable) are also covered. However, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. The cost sharing includes a $35 copay for Medicare Part B Insulin Drugs, with coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Mercy Care Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, with no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, and require prior authorization and a doctor's referral. For Diagnostic Procedures/Tests, and Lab Services, you pay at most 20% coinsurance. For Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, you pay at most 20% coinsurance.
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. However, 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. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Mercy Care Advantage (HMO D-SNP) plan, but the cost sharing details are not provided. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services offered by Mercy Care Advantage (HMO D-SNP) include Over-the-Counter (OTC) Items, with a maximum benefit of $100 per month, and Meal Benefits requiring prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered.
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