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Saint Alphonsus Health Plan Cash Back (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Saint Alphonsus Health Plan Cash Back (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 Cash Back (HMO) in 2026, please refer to our full plan details page.
Saint Alphonsus Health Plan Cash Back (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 2026.
It's important to know that Saint Alphonsus Health Plan Cash Back (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 Cash Back (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 Cash Back (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 $102.10. 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 a $325.00 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 $7900.00 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 Saint Alphonsus Health Plan Cash Back (HMO)
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Drug Coverage
The Saint Alphonsus Health Plan Cash Back (HMO) features an annual prescription drug deductible of $325. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies or through standard mail order. Tier 2 generic drugs are also highly affordable, featuring no copay for standard mail order and copays starting at just $2 for a one-month supply at preferred pharmacies. Brand-name and specialty medications are covered under coinsurance rather than flat copays. Tier 3 preferred brands require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 35% coinsurance. Specialty drugs in Tier 5 are available with a 29% coinsurance for a one-month supply, with these coinsurance rates applying across preferred pharmacies, standard pharmacies, and standard mail order.
Additional Benefits
The Saint Alphonsus Health Plan Cash Back (HMO) offers comprehensive coverage with no copays or coinsurance for primary care visits, routine annual physicals, routine eye and hearing exams, and home health services. Members also benefit from preventive dental services with no copay up to a $1,000 annual limit, plus a $125 yearly allowance for eyewear. Additionally, over-the-counter items and meals for chronic illnesses are available with no copay or coinsurance. For specialized medical needs, specialist visits require a $40 copay, while emergency room visits carry a $115 copay that is waived if you are admitted within 48 hours. Inpatient hospital stays require a $450 daily copay for the first five days, with no copay for subsequent days. Durable medical equipment, prosthetics, and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Saint Alphonsus Health Plan Cash Back (HMO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Acute stays require a $450 daily copay for days 1-5 (no copay for days 6 and beyond), while psychiatric stays require a $415 daily copay for days 1-5 (no copay for days 6-90). Upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered.
Outpatient Services See details
Saint Alphonsus Health Plan Cash Back (HMO) covers outpatient services with no coinsurance, featuring a $10.00 to $450.00 copay for outpatient hospital services and a $405.00 copay per stay for observation services. Ambulatory surgical center services require a $450.00 copay, outpatient substance abuse sessions carry a $40.00 copay, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization services are covered by the Saint Alphonsus Health Plan Cash Back (HMO) with a $60.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Saint Alphonsus Health Plan Cash Back (HMO) covers ambulance services with no coinsurance, requiring prior authorization and a copay of $275 for ground ambulance and $325 for air ambulance. For transportation benefits, some services are covered but trips to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Saint Alphonsus Health Plan Cash Back (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency and urgent care carry a $115 copay, and worldwide emergency transportation costs between a $275 and $325 copay, all with no coinsurance.
Primary Care See details
Primary Care benefits under the Saint Alphonsus Health Plan Cash Back (HMO) include primary care physician visits with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Physical, occupational, and speech therapy services require a $35 copay with no coinsurance, while mental health, psychiatric, and opioid treatment services carry a $40 copay and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Saint Alphonsus Health Plan Cash Back (HMO) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, and fitness benefits, with no copays and no coinsurance. However, these benefits are only partially covered, as sub-services like health education, weight management programs, in-home safety assessments, and nutritional counseling are not covered.
Hearing Services See details
Hearing services are covered by Saint Alphonsus Health Plan Cash Back (HMO), featuring a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $599 to $899 for up to two devices per year, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Saint Alphonsus Health Plan Cash Back (HMO) with no deductibles or coinsurance, featuring no copay for one annual routine eye exam and no copay for eyewear up to a $125 yearly limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by the Saint Alphonsus Health Plan Cash Back (HMO), offering Medicare-covered dental at a $40 copay and no coinsurance, alongside diagnostic and preventive services with no copay and no coinsurance up to a $1,000 annual limit. Restorative services and oral surgery are covered with no copay and 50% coinsurance, but other preventive services, endodontics, periodontics, prosthodontics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Saint Alphonsus Health Plan Cash Back (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis services are covered under the Saint Alphonsus Health Plan Cash Back (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Saint Alphonsus Health Plan Cash Back (HMO) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Saint Alphonsus Health Plan Cash Back (HMO) with no coinsurance for diagnostic tests and lab services, which carry copays of $50 and $10 respectively. Outpatient X-rays require a $40 copay, diagnostic radiology has a minimum $145 copay, and therapeutic radiology services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Saint Alphonsus Health Plan Cash Back (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under the Saint Alphonsus Health Plan Cash Back (HMO). However, only some services are covered, as standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Saint Alphonsus Health Plan Cash Back (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day hospital stay. There is no copay for days 1 to 20 and days 61 to 100, a $218 daily copay for days 21 to 60, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by the Saint Alphonsus Health Plan Cash Back (HMO), excluding dual-eligible SNP services and other unspecified benefits. Covered options include acupuncture with a $20 copay and no coinsurance (up to 6 treatments per year with prior authorization required), as well as over-the-counter items and chronic illness meals, both available with no copay and no coinsurance.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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