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IU Health Plans Medicare Select - Medical Only (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for IU Health Plans Medicare Select - Medical Only (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on IU Health Plans Medicare Select - Medical Only (HMO) in 2025, please refer to our full plan details page.
IU Health Plans Medicare Select - Medical Only (HMO) is a HMO plan offered by Indiana University Health available for enrollment in 2025 to people living in State of Indiana - 26 counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that IU Health Plans Medicare Select - Medical Only (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about IU Health Plans Medicare Select - Medical Only (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 IU Health Plans Medicare Select - Medical Only (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 $21.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5000.00 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 IU Health Plans Medicare Select - Medical Only (HMO)
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Drug Coverage
Prescription drugs are not covered by IU Health Plans Medicare Select - Medical Only (HMO).
Additional Benefits
The IU Health Plans Medicare Select - Medical Only (HMO) plan offers a range of benefits, including inpatient and outpatient hospital care with varying copays, and coverage for ambulance and emergency services. Primary care, preventive, vision, and dental services are also included, with copays for exams and specific procedures. The plan also covers home health, skilled nursing, and dialysis services, along with medical equipment and diagnostic services with coinsurance or copays.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $395 copay for days 1-6, and no copay for days 7-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric services, you'll pay a $380 copay for days 1-6, and no copay for days 7-90; additional days are not covered. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a $350 copay, and Ambulatory Surgical Center (ASC) Services with a $300 copay. Outpatient Substance Abuse Services are covered with a copay of $40 for both individual and group sessions, while Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the IU Health Plans Medicare Select - Medical Only (HMO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $295 copay for both ground and air ambulance services. Transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year. Transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services, are covered under this plan. Emergency Services have a $125 copay and no coinsurance, while urgently needed services have a $55 copay and no coinsurance; however, worldwide emergency services and transportation are not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services have a $20 copay, and Routine Chiropractic Care is not covered. Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services have a $25 copay. Physician Specialist Services have a $40 copay. Individual and Group Sessions for Mental Health and Psychiatric Services each have a $40 copay. Other Health Care Professional and Opioid Treatment Program Services have a minimum and maximum copay of $40.
Preventive Services See details
The IU Health Plans Medicare Select - Medical Only (HMO) plan covers preventive services, including annual physical exams, health education, wigs for hair loss related to chemotherapy, fitness benefits, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. In-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, 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, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a $40 copay for each routine exam, with one exam covered per year. Prescription hearing aids are covered with a copay between $499 and $999, with 2 hearing aids covered per year, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $40 copay, and eyewear including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Eyewear has a combined maximum plan benefit coverage of $250 every two years.
Dental Services See details
The IU Health Plans Medicare Select - Medical Only (HMO) plan covers oral exams, dental x-rays, prophylaxis (cleaning), and adjunctive general services with no coinsurance, but fluoride treatment, implant services, and orthodontics are not covered. Restorative services and oral and maxillofacial surgery are covered with a 50% coinsurance. Other diagnostic dental services, endodontics, periodontics, prosthodontics (removable and fixed), and maxillofacial prosthetics are offered as optional, supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the IU Health Plans Medicare Select - Medical Only (HMO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered under the IU Health Plans Medicare Select - Medical Only (HMO) plan, including Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies with 20% coinsurance, while Diabetic Equipment is partially covered, with Diabetic Supplies not covered and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures, lab services, and radiological services. Diagnostic Procedures/Tests have a coinsurance of at most 20%, while lab services have no copay. Diagnostic Radiological Services have a coinsurance of at most 20% and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the IU Health Plans Medicare Select - Medical Only (HMO) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by this plan. No copay or coinsurance information is available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the IU Health Plans Medicare Select - Medical Only (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The IU Health Plans Medicare Select - Medical Only (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $40.00 every three months, and also covers a meal benefit for chronic illnesses, but acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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