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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 2025, 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 5 out of 5 stars in 2025.
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 $50.60. 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 Iowa Health Advantage (HMO I-SNP) plan has a prescription drug deductible of $590. Once you meet your deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D will be $50.60. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Iowa Health Advantage (HMO I-SNP) plan offers a wide range of benefits. You can expect no copay for primary care, home health services, skilled nursing facility days 1-100, and lab services. The plan also covers hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids with no copay. Many services have a 20% coinsurance, including outpatient services, ambulance, emergency services, vision and dental services, and medical equipment. You should note that prior authorization is required for inpatient hospital stays, partial hospitalization, home infusion services, diagnostic and radiological services, cardiac rehabilitation, and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered and require prior authorization. The plan charges the Medicare-defined cost share for tier 1, and additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for 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 Ambulatory Surgical Center (ASC) Services, Individual Sessions for Outpatient Substance Abuse, 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, including ground and air ambulance services with a 20% coinsurance. Transportation Services to any health-related location are covered with no copay for up to 36 one-way trips per year, while transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Iowa Health Advantage (HMO I-SNP) plan. For Emergency and Urgently Needed Services, there is a 20% coinsurance, and for Worldwide Emergency Services, the plan does not cover Worldwide Emergency Coverage, Worldwide Urgent Coverage, or Worldwide Emergency Transportation.
Primary Care See details
The Iowa Health Advantage (HMO I-SNP) plan covers primary care physician services with no copay, chiropractic services with 20% coinsurance, occupational therapy services with 0-20% coinsurance, and physician specialist services with 0-20% coinsurance. The plan also covers mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits with no copay, and opioid treatment program services with no copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, and additional preventive services, In-Home Support Services, Kidney Disease Education Services, and Other Preventive Services. Additional preventive services require a doctor referral and may have a copay, while the other services have no copay. Services not covered include annual physical exams, health education, in-home safety assessment, personal emergency response system, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefit, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing services include routine hearing exams with no copay and at most 20% coinsurance, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
The Iowa Health Advantage (HMO I-SNP) plan covers vision services, including eye exams and eyewear. Eye exams have a 20% coinsurance for routine eye exams, and eyewear has a 20% coinsurance, with a maximum plan benefit coverage of $300. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
Dental services are partially covered by the Iowa Health Advantage (HMO I-SNP) plan, with Medicare Dental Services covered at a 20% coinsurance. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Iowa Health Advantage (HMO I-SNP) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests and Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services have no copay.
Home Health Services See details
Home Health Services are covered by the Iowa Health Advantage (HMO I-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and there is coinsurance for the services that are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Iowa Health Advantage (HMO I-SNP) plan, but require prior authorization. There is no copay for days 1-100.
Other Services See details
The Iowa Health Advantage (HMO I-SNP) plan does not cover acupuncture, over-the-counter items, meal benefits, 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, or Self-Directed Personal Assistance Services. No authorization or referrals are required for these services.
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