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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 Arizona Statewide. 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 $15.20. 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 yearly prescription drug deductible of $615.00. If you qualify for the low-income subsidy, also known as Extra Help, your Part D premium is reduced to $15.20. After meeting your deductible, you pay cost-sharing amounts in the initial coverage phase until your total drug costs reach $2,100.00. Once your yearly out-of-pocket drug costs reach $2,100.00, you transition into the catastrophic coverage phase. In this phase, there is no copay for Medicare Part D covered drugs, though you may still pay a share of the costs for any excluded drugs. To ensure your specific prescriptions are included, you should check the plan's formulary.
Additional Benefits
The Mercy Care Advantage (HMO D-SNP) plan offers comprehensive medical coverage with a predictable cost structure, generally requiring no copay and a 20% coinsurance for outpatient, emergency, primary care, and diagnostic services. Inpatient hospital care and skilled nursing facility stays are subject to Original Medicare-defined copays and coinsurance, while standard Medicare preventive services are available with no copay and no coinsurance. Beyond basic medical care, this plan provides valuable supplemental benefits including up to $5,000 annually for dental services and a $1,900 prescription hearing aid allowance every four years. Members also receive a $300 annual vision eyewear limit, up to 12 one-way transportation trips per year, and a $100 monthly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Mercy Care Advantage (HMO D-SNP), with cost-sharing following Original Medicare-defined copays and coinsurance, and prior authorization required. Uncovered sub-services include additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric stays.
Outpatient Services See details
Mercy Care Advantage (HMO D-SNP) covers outpatient services—including outpatient hospital, observation, ambulatory surgical, substance abuse, and blood services—with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required for these covered benefits.
Partial Hospitalization See details
Mercy Care Advantage (HMO D-SNP) covers partial hospitalization benefits with a 20% coinsurance and no copay. Prior authorization is required to access these covered 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, offering up to 12 one-way trips per year to plan-approved locations with prior authorization, while transportation to any health-related location is not covered.
Emergency Services See details
Mercy Care Advantage (HMO D-SNP) offers partially covered emergency services with no copay and a 20% coinsurance for both emergency and urgently needed services. Worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Primary Care benefits are partially covered by Mercy Care Advantage (HMO D-SNP) with a 20% coinsurance and no copay for most services, including physician, specialist, and therapy visits. However, routine chiropractic care is not covered under this plan.
Preventive Services See details
Mercy Care Advantage (HMO D-SNP) partially covers preventive services, offering Medicare-covered zero-dollar preventive services with no copay and no coinsurance. Other covered benefits, including kidney disease education and glaucoma screenings, require a 20% coinsurance and no copay, while annual physical exams, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by Mercy Care Advantage (HMO D-SNP), which offers routine hearing exams and fitting evaluations with a 20% coinsurance and no copay. The plan provides up to a $1,900 allowance every 4 years for prescription hearing aids, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription devices are not covered.
Vision Services See details
Mercy Care Advantage (HMO D-SNP) covers vision services with no copay and a 20% coinsurance, including one routine eye exam per year and a $300 annual limit for eyewear. This benefit is partially covered, as contact lenses and eyeglasses (lenses and frames) are covered, while individual eyeglass lenses, eyeglass frames, and upgrades are not.
Dental Services See details
Mercy Care Advantage (HMO D-SNP) covers Medicare dental services with a 20% coinsurance and no copay, alongside other dental services up to a maximum benefit of $5,000 per year. These dental services are partially covered, as 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 Part B chemotherapy and other drugs, for no copay and a coinsurance ranging from no coinsurance to 20%. Part B insulin drugs are covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Mercy Care Advantage (HMO D-SNP) covers dialysis services 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, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetic devices.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Mercy Care Advantage (HMO D-SNP) with no copay and a 20% coinsurance. These services, which include lab tests, diagnostic procedures, therapeutic radiology, and outpatient X-rays, require prior authorization and a doctor referral.
Home Health Services See details
Home health services are covered under the Mercy Care Advantage (HMO D-SNP) plan, although prior authorization is required. Specific copayment and coinsurance costs are not specified in the plan benefits.
Cardiac Rehabilitation Services See details
Mercy Care Advantage (HMO D-SNP) does not cover Cardiac Rehabilitation Services, as all associated sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Mercy Care Advantage (HMO D-SNP) and require prior authorization, with cost-sharing subject to Medicare-defined copays and coinsurance. While standard SNF services do not require a prior three-day inpatient hospital stay, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Mercy Care Advantage (HMO D-SNP), with acupuncture and dual eligible SNPs with highly integrated services excluded from coverage. The plan provides a $100 monthly allowance for over-the-counter items and limited-duration meal benefits for chronic illnesses with prior authorization.
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