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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 Arizona Statewide. 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 $2.20. 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 deductible of $590.00. After the deductible, your costs will vary depending on the drug tier and pharmacy you use. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). After your total drug costs reach $2000.00, you will enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Mercy Care Advantage (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $1630 copay per admission, while outpatient services and emergency services have a 20% coinsurance. Many services, including primary care, preventive services, and home health services, are covered, with some requiring coinsurance or prior authorization. Additional benefits include coverage for hearing, vision, and dental services, each with specific cost-sharing structures. The plan also provides coverage for ambulance and transportation, as well as durable medical equipment and home infusion services. Furthermore, the plan includes an over-the-counter (OTC) allowance and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a copay of $1630 per admission or stay. Additional days, upgrades, and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services and observation services, are covered with a 20% coinsurance. Outpatient Substance Abuse Services are covered, including both individual and group sessions with a coinsurance between 20% and 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered with prior authorization, and requires a 20% coinsurance.
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, and transportation services to a plan-approved health-related location are covered for up to 42 one-way trips per year.
Emergency Services See details
Emergency Services are covered with a 20% coinsurance, and there is no copay. Urgently Needed Services are covered with a 20% coinsurance, and there is no copay. 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 the Mercy Care Advantage (HMO D-SNP) plan. Primary Care Physician Services, Physical Therapy, and Speech-Language Pathology Services have a 20% coinsurance. Chiropractic Services, Physician Specialist Services, and Routine Foot Care also have a 20% coinsurance. Individual and Group Sessions for Mental Health and Psychiatric Services have a 20% coinsurance. Other Health Care Professional services and Opioid Treatment Program Services have a minimum and maximum 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, plus additional services like Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Kidney Disease Education Services. Kidney Disease Education Services and Diabetes Self-Management Training have a 20% coinsurance, while Medicare-covered barium enemas have a coinsurance.
Hearing Services See details
Hearing Services include routine hearing exams with at most 20% coinsurance, fitting/evaluation for hearing aids, and prescription hearing aids with a maximum plan benefit of $1900 every two years. Prescription hearing aids - inner ear, outer ear, and over the ear 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 include routine eye exams. Eyewear also has a 20% coinsurance, and includes contact lenses, and eyeglasses (lenses and frames), but not eyeglass lenses, eyeglass frames, or upgrades.
Dental Services See details
The Mercy Care Advantage (HMO D-SNP) plan covers dental services, including Medicare Dental Services with 20% coinsurance. Other dental services include oral exams (1 visit every six months), dental x-rays (1 per year), prophylaxis (cleaning, 1 visit every six months), fluoride treatment (1 visit 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, while maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Mercy Care Advantage (HMO D-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
The Mercy Care Advantage (HMO D-SNP) plan covers medical equipment, including durable medical equipment (DME) with 20% coinsurance and diabetic equipment with 20% coinsurance for diabetic supplies and diabetic therapeutic shoes/inserts. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. There is no copay for these services, but you may have to pay up to 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, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is coinsurance for 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. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. Prior authorization is required, and the copay information is available in the plan details.
Other Services See details
The Mercy Care Advantage (HMO D-SNP) plan covers Over-the-Counter (OTC) items with a maximum benefit of $100.00 every month, and a meal benefit that requires prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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