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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 2025, please refer to our full plan details page.
Saint Alphonsus Health Plan No Premium (HMO) is a HMO plan offered by Trinity Health Corporation available for enrollment in 2025 to people living in Select Counties in Idaho. This plan received an overall rating of 4 out of 5 stars in 2025.
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 $12.70. You must continue to pay paying your reduced 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5500.00 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 Saint Alphonsus Health Plan No Premium (HMO) has an enhanced alternative drug benefit plan. This plan has no deductible. In the initial coverage phase, you will pay a $6 copay for preferred generic drugs at a preferred pharmacy and 25% coinsurance for standard generic drugs. For preferred brand drugs, you will pay 50% coinsurance, and for non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Saint Alphonsus Health Plan No Premium (HMO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and emergency services. The plan covers primary care, preventive services, and specialized services like hearing, vision, and dental, with varying copays for different services. This plan also includes coverage for ambulance services, home health, and medical equipment, with copays or coinsurance depending on the service. Additional benefits encompass over-the-counter items and meal benefits.
Inpatient Hospital See details
Inpatient hospital services are covered, with a copay of $275 for days 1-4, and no copay for days 5-90 for acute care and psychiatric care. Additional days for inpatient hospital acute care are covered with no copay, while non-Medicare-covered stays and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $250, observation services with no copay, ambulatory surgical center services with a $250 copay, individual and group sessions for outpatient substance abuse with a $30 copay, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Saint Alphonsus Health Plan No Premium (HMO) plan. Ground ambulance services have a $250 copay, while air ambulance services have a $300 copay, and there is no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Saint Alphonsus Health Plan No Premium (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Transportation has a $250-$300 copay; all services have no coinsurance.
Primary Care See details
The Saint Alphonsus Health Plan No Premium (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $30 copay, and physician specialist services with a $30 copay. Mental health specialty services have a $30 copay for individual and group sessions, while psychiatric services have a $30 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits range from no copay to a $30 copay, and opioid treatment program services have a $30 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services. Additional preventive services include Fitness Benefit, and Remote Access Technologies, which have no copay. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all of which have no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (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, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, with a $30 copay for hearing exams and no copay for routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered, with a copay between $599 and $899 for all types of prescription hearing aids, but 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 coverage for eye exams with a copay between $0 and $30, and eyewear with no copay. Routine eye exams are covered with no copay, and eyeglasses and contact lenses are covered with no copay.
Dental Services See details
The Saint Alphonsus Health Plan No Premium (HMO) plan covers dental services with a $30 copay for Medicare dental services, and no copay for other dental services. Other services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and restorative services with a 50% coinsurance, and also covers endodontics and periodontics with a 70% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Saint Alphonsus Health Plan No Premium (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable medical equipment has a 20% coinsurance and requires authorization, while durable medical equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies have a 20% coinsurance. Diabetic supplies have no copay, and diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a $20 copay and lab services with no copay. Outpatient X-ray services have a $20 copay, while diagnostic radiological services have a $115 copay and therapeutic radiological services have a 20% coinsurance.
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, but Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Saint Alphonsus Health Plan No Premium (HMO). The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by this plan, with no copay for days 1-20 and days 56-100, but a $214 copay for days 21-55. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture with a $20 copay, and Over-the-Counter (OTC) Items with no copay, and a $105 maximum plan benefit coverage amount every three months. Meal Benefit is also covered with no copay. Additionally, the plan does not cover the following: 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.
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