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Saint Alphonsus Health Plan No Premium (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Saint Alphonsus Health Plan No Premium (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Saint Alphonsus Health Plan No Premium (HMO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Saint Alphonsus Health Plan No Premium (HMO) is a HMO plan offered by Mount Carmel Health Plan of Idaho, Inc. available for the 2026 plan year to people living in Select Counties in Idaho. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Saint Alphonsus Health Plan No Premium (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Saint Alphonsus Health Plan No Premium (HMO).
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 Saint Alphonsus Health Plan No Premium (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $4.50. You must continue to pay paying your reduced Part B Premium.
Deductibles
Health deductible: information not available.
This plan has a $225.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5500.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5500.00 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 Saint Alphonsus Health Plan No Premium (HMO)
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Drug Coverage
The Saint Alphonsus Health Plan No Premium (HMO) features an annual drug deductible of $225. For Tier 1 preferred generic drugs, you pay no copay at preferred pharmacies or through standard mail order, while standard pharmacies charge a $10 to $30 copay. Tier 2 generic drugs also offer no copay through standard mail order, with copays starting at $2 at preferred pharmacies and ranging from $20 to $60 at standard pharmacies. Higher-tier prescription drugs under this plan require coinsurance instead of flat copays. Tier 3 preferred brand drugs have a 25% coinsurance, and Tier 4 non-preferred drugs require a 35% coinsurance across all pharmacy types. Tier 5 specialty drugs are covered at a 30% coinsurance for a one-month supply.
Additional Benefits
The Saint Alphonsus Health Plan No Premium (HMO) offers affordable healthcare coverage with no copay for primary care physician visits and a $30 copay for specialist visits. For inpatient hospital stays, members pay a $300 daily copay for days 1 through 5, followed by no copay for days 6 through 90. Emergency room visits require a $130 copay, which is waived upon hospital admission, while urgent care services are available for a $45 copay. Preventive care, routine eye exams, and home health services are covered with no copay or coinsurance, alongside a $1,000 annual dental benefit and a $200 eyewear allowance. Diagnostic lab tests have no copay, while durable medical equipment and dialysis services require a 20% coinsurance. This plan also includes helpful extras like a $75 quarterly over-the-counter allowance with no copay.
Inpatient Hospital See details
Saint Alphonsus Health Plan No Premium (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute care days are covered with no copay.
Outpatient Services See details
Saint Alphonsus Health Plan No Premium (HMO) covers outpatient services with no coinsurance, featuring outpatient hospital copays ranging from no copay to $325 and ambulatory surgical center services for a $325 copay. Outpatient substance abuse sessions carry a $30 copay with no coinsurance, and outpatient blood services have no copay, coinsurance, or deductible.
Partial Hospitalization See details
Saint Alphonsus Health Plan No Premium (HMO) covers partial hospitalization services with a $40.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Saint Alphonsus Health Plan No Premium (HMO) covers ambulance services with no coinsurance, requiring prior authorization and a copay of $250 for ground ambulance and $300 for air ambulance. Transportation services are not covered under this plan.
Emergency Services See details
Emergency services under the Saint Alphonsus Health Plan No Premium (HMO) are covered with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services have a $45 copay and no coinsurance, while worldwide emergency services feature no coinsurance and copays of $130 for emergency or urgent care and $250 to $300 for emergency transportation.
Primary Care See details
Saint Alphonsus Health Plan No Premium (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $30 copay and no coinsurance. Some chiropractic services are covered with a $15 copay and no coinsurance, though routine and other chiropractic services are not covered, and podiatry services are not covered.
Preventive Services See details
Saint Alphonsus Health Plan No Premium (HMO) covers key preventive services, including annual physical exams, kidney disease education, fitness benefits, and select screenings, with no copays and no coinsurance. These benefits are partially covered, as supplemental services such as health education, weight management programs, personal emergency response systems, and nutritional counseling are not covered.
Hearing Services See details
Hearing services covered by Saint Alphonsus Health Plan No Premium (HMO) include routine exams and fitting evaluations with no copay and no coinsurance, plus Medicare-covered exams for a $30 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $599 to $899 for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Saint Alphonsus Health Plan No Premium (HMO), which offers routine eye exams (one per year) and eyewear with no copay, no coinsurance, and no deductible. Covered eyewear includes contact lenses and eyeglasses up to a $200 yearly limit, but other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Saint Alphonsus Health Plan No Premium (HMO) partially covers dental services up to a $1,000 annual limit, offering Medicare-covered dental for a $30 copay and no coinsurance, and preventive care with no copay and no coinsurance. Comprehensive benefits have no copays and coinsurance ranging from 0% to 70%, but implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Saint Alphonsus Health Plan No Premium (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance of 0% to 20%, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Saint Alphonsus Health Plan No Premium (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Saint Alphonsus Health Plan No Premium (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Saint Alphonsus Health Plan No Premium (HMO) covers diagnostic services with no coinsurance, requiring a $20 copay for procedures and tests and no copay for lab services. Covered radiological services include outpatient X-rays for a $20 copay, therapeutic radiology with a 20% coinsurance, and diagnostic radiology with no copay.
Home Health Services See details
Home health services are covered by the Saint Alphonsus Health Plan No Premium (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Saint Alphonsus Health Plan No Premium (HMO) provides Cardiac Rehabilitation Services with no coinsurance, though in practice only some services are covered. Standard cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($15 copay) are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by the Saint Alphonsus Health Plan No Premium (HMO) with no coinsurance and no prior three-day hospital stay required. There is no copay for days 1 through 20 and days 61 through 100, but a $218 daily copay applies for days 21 through 60, with days beyond the Medicare-covered limit not covered.
Other Services See details
Saint Alphonsus Health Plan No Premium (HMO) covers acupuncture with a $20 copay and no coinsurance for up to 6 treatments per year, which requires prior authorization. The plan also provides meals for chronic illness and a $75 quarterly over-the-counter item allowance, both with no copay and no coinsurance.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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