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Iowa Health Advantage (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Iowa Health Advantage (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Iowa Health Advantage (HMO I-SNP) in 2026, please refer to our full plan details page.
Iowa Health Advantage (HMO I-SNP) is a HMO I-SNP plan offered by Mitchell Family Office available for enrollment in 2025 to people living in Iowa. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Iowa Health Advantage (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Iowa Health Advantage (HMO I-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 Iowa Health Advantage (HMO I-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 Iowa Health Advantage (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $41.50. 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 Iowa Health Advantage (HMO I-SNP) Medicare Advantage plan features an annual prescription drug deductible of $615. This means you will need to pay this deductible amount out of pocket before the plan begins covering your prescription medication costs. Specific drug tier details, copayments, and coinsurance percentages are not available for this plan. To determine your exact costs for specific prescriptions, it is recommended to consult the plan's comprehensive formulary or contact the provider directly.
Additional Benefits
The Iowa Health Advantage (HMO I-SNP) plan offers robust medical coverage with many essential services requiring no copay. Members benefit from no copay and no coinsurance for primary care, home health services, and skilled nursing facility stays up to 100 days. Outpatient care, emergency services, and specialist visits generally feature no copay alongside a 20% coinsurance. This plan also includes valuable supplemental benefits, such as up to 38 one-way transportation trips per year to health-related locations with no copay and no coinsurance. Vision and hearing benefits feature no copays for routine exams, alongside annual allowances for eyewear and hearing aids. However, routine dental care, fitness programs, and over-the-counter items are not covered under this plan.
Inpatient Hospital See details
Iowa Health Advantage (HMO I-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance and Medicare-defined copayments, though prior authorization is required. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Iowa Health Advantage (HMO I-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital, observation, and ambulatory surgical center services.
Partial Hospitalization See details
Partial hospitalization services are covered under the Iowa Health Advantage (HMO I-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Iowa Health Advantage (HMO I-SNP), with ground and air ambulance services requiring prior authorization and a 20% coinsurance with no copay. Transportation services are partially covered, featuring no copay and no coinsurance for up to 38 one-way trips per year to any health-related location, while transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Iowa Health Advantage (HMO I-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, which counts toward the plan's deductible and is waived if you are admitted to the hospital within one day. For worldwide emergency services, some services are covered but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Iowa Health Advantage (HMO I-SNP) covers primary care, telehealth, and opioid treatment services with no copay and no coinsurance, while chiropractic services are not covered. Specialist visits, occupational, physical, and speech therapies, mental health, psychiatric, and podiatry services are also covered with no copay and 0% to 20% coinsurance.
Preventive Services See details
Iowa Health Advantage (HMO I-SNP) covers Medicare-covered preventive services, kidney disease education, select screenings, and in-home support services with no copay and no coinsurance. However, preventive services are only partially covered, as annual physical exams and most supplemental benefits—such as fitness programs, health education, and weight management—are not covered.
Hearing Services See details
Iowa Health Advantage (HMO I-SNP) provides partially covered hearing services with no deductible, featuring one routine exam per year with no copay and 20% coinsurance, and unlimited hearing aid fittings with no copay. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Iowa Health Advantage (HMO I-SNP) partially covers vision services with no deductibles, excluding other eye exam services which are not covered. Routine eye exams are covered once annually with no copay and a 20% coinsurance, while eyewear is covered up to $300 per year with no copay and no coinsurance, except for contact lenses which require a 20% coinsurance.
Dental Services See details
Iowa Health Advantage (HMO I-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance. Routine and comprehensive dental services, including oral exams, cleanings, x-rays, fluoride, restorative care, endodontics, periodontics, prosthodontics, and orthodontics, are not covered.
Home Infusion bundled Services See details
Iowa Health Advantage (HMO I-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Iowa Health Advantage (HMO I-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Iowa Health Advantage (HMO I-SNP) covers medical equipment, offering no copay and a 20% coinsurance for durable medical equipment, prosthetic devices, and medical supplies. Diabetic supplies and therapeutic shoes or inserts are also covered with no copay and no coinsurance, though prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Iowa Health Advantage (HMO I-SNP), though prior authorization is required. Diagnostic procedures and tests require a copay and 20% coinsurance, lab services have no copay, and radiological services—including X-rays, therapeutic, and diagnostic radiology—require no copay and a 20% coinsurance.
Home Health Services See details
Iowa Health Advantage (HMO I-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Iowa Health Advantage (HMO I-SNP) with no copay and require prior authorization. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Iowa Health Advantage (HMO I-SNP) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the Iowa Health Advantage (HMO I-SNP) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage. Since these services are not covered, there are no copays or coinsurance options available, and members must pay the full cost out of pocket.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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