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Iowa Health Advantage Choice (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Iowa Health Advantage Choice (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 Choice (HMO I-SNP) in 2025, please refer to our full plan details page.
Iowa Health Advantage Choice (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 Choice (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 Choice (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 Choice (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 Choice (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:
Sign up for Iowa Health Advantage Choice (HMO I-SNP)
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Drug Coverage
The Iowa Health Advantage Choice (HMO I-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2,000. This plan's premium may be reduced if you qualify for the low-income subsidy, and the monthly premium would be $50.60. Once your yearly out-of-pocket drug costs reach $2,000, you pay nothing for covered drugs.
Additional Benefits
The Iowa Health Advantage Choice (HMO I-SNP) plan offers coverage for a wide array of services, including inpatient and outpatient care, with a 20% coinsurance for many services such as outpatient hospital, emergency, and ambulance services. Primary care physician services have no copay, and the plan also provides benefits for hearing, vision, and dental services, though some dental procedures are not covered. Additional benefits include home health services with no copay, and coverage for medical equipment and diagnostic services, with varying coinsurance amounts. The plan also covers skilled nursing facility stays for the first 100 days at no cost, and offers an over-the-counter (OTC) benefit with a monthly allowance. However, it's important to note that some services, like additional days in the hospital, and certain dental and vision services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but the plan does not specify the cost sharing. Additional days, non-Medicare-covered stays, and upgrades for inpatient hospital acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a coinsurance of 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by Iowa Health Advantage Choice (HMO I-SNP), with a 20% coinsurance. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a 20% coinsurance, and there is no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered with a 20% coinsurance. Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care Physician Services have no copay. Chiropractic Services are partially covered, with routine care not covered and a 20% coinsurance for covered services. Occupational Therapy Services are covered with a 0-20% coinsurance. Physician Specialist Services have a 0-20% coinsurance. Mental Health Specialty Services, including individual and group sessions, have a 0-20% coinsurance. Podiatry Services, including routine foot care, are covered with a 0-20% coinsurance and no copay. Other Health Care Professional services have a 0-20% coinsurance. Psychiatric Services, including individual and group sessions, have a 0-20% coinsurance. Physical Therapy and Speech-Language Pathology Services have a 0-20% coinsurance. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive services are covered, but annual physical exams, health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), 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 are not covered. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit have no copay. In-home support services have no copay. Additional preventive services have a copay, and require a doctor referral.
Hearing Services See details
Hearing Services includes coverage for hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, with no deductible. Routine hearing exams have no copay and a 20% coinsurance, while fitting/evaluation for hearing aids has no copay and no coinsurance. Prescription hearing aids (all types) have no copay and are limited to 2 visits per year, with a maximum benefit of $500 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. 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 have no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services; however, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), 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 Choice (HMO I-SNP) plan. You are responsible for 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. 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, have a coinsurance of at most 20%, while Lab Services have no copay. Therapeutic Radiological Services, Diagnostic Radiological Services, and Outpatient X-Ray Services each have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Iowa Health Advantage Choice (HMO I-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 generally covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is coinsurance for some services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Iowa Health Advantage Choice (HMO I-SNP) plan with no copay for days 1-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other services include Over-the-Counter (OTC) items, with a $0 copay and a maximum benefit of $105.00 per month. Acupuncture, 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, and Self-Directed Personal Assistance Services are not covered.
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