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IU Health Plans Medicare Choice (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for IU Health Plans Medicare Choice (HMO-POS). 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 Choice (HMO-POS) in 2025, please refer to our full plan details page.
IU Health Plans Medicare Choice (HMO-POS) is a HMO-POS plan offered by Indiana University Health available for enrollment in 2025 to people living in State of Indiana - 20 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 Choice (HMO-POS) 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 IU Health Plans Medicare Choice (HMO-POS).
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 Choice (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $105.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6850.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $6850.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Choice (HMO-POS)
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Drug Coverage
The IU Health Plans Medicare Choice (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, standard generic drugs have a $15 copay, while preferred brand drugs have a 50% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The IU Health Plans Medicare Choice (HMO-POS) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays depending on the specific service. Emergency and primary care services also have copays, and the plan offers coverage for hearing, vision, and dental care with specific copays or coinsurance. This plan also covers ambulance and transportation services, home health, and skilled nursing facilities. Additionally, the plan includes coverage for diagnostic and radiological services, medical equipment, and home infusion services, with some services requiring copays or coinsurance. The plan also offers an over-the-counter benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $395 for days 1-6, and no copay for days 7-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric also has a copay of $335 for days 1-6, and no copay for days 7-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services and observation services with a $350 copay, ambulatory surgical center services with a $250 copay, and outpatient substance abuse services with a copay between $35.00 and $35.00 for both individual and group sessions, but outpatient blood services are not covered. Prior authorization is required for many of these services.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the IU Health Plans Medicare Choice (HMO-POS) plan. Ground and air ambulance services have a $295 copay, and transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the IU Health Plans Medicare Choice (HMO-POS) plan. Emergency Services have a $110 copay with no coinsurance, while Urgently Needed Services have a $45 copay with no coinsurance; however, Worldwide Emergency Services, including coverage, urgent coverage, and transportation, are not covered.
Primary Care See details
Primary Care Physician Services have a copay between $0 and $10. Chiropractic Services have a $15 copay, but Routine Care is not covered. Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services have a $25 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $35 copay for individual and group sessions. Other Health Care Professional services have a $35 copay. Additional Telehealth Benefits are also covered. Podiatry Services are not covered.
Preventive Services See details
The IU Health Plans Medicare Choice (HMO-POS) 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 EKG following a Welcome Visit. However, 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, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $35 copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $499 and $999, but prescription hearing aids for inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a $35 copay, and eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, with a combined maximum benefit of $250 every two years. Upgrades are not covered.
Dental Services See details
The IU Health Plans Medicare Choice (HMO-POS) plan covers dental services, including oral exams and dental X-rays with no coinsurance, and prophylaxis (cleaning) with no coinsurance, up to a maximum of $1500 per year. Restorative Services and Oral and Maxillofacial Surgery have a 50% coinsurance, and Adjunctive General Services has no coinsurance. Fluoride treatment, 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. 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 under the IU Health Plans Medicare Choice (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment and supplies are covered with a coinsurance, but Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the IU Health Plans Medicare Choice (HMO-POS) plan. Diagnostic Procedures/Tests and Therapeutic Radiological Services have a coinsurance of up to 20%, while Lab Services have no copay. Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the IU Health Plans Medicare Choice (HMO-POS) plan, with no copay or coinsurance, though authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the IU Health Plans Medicare Choice (HMO-POS) plan, but the plan does not cover the sub-services including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. There is a copay, but the amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the IU Health Plans Medicare Choice (HMO-POS) plan, with a prior authorization requirement. You will have no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and a Meal Benefit, but acupuncture, 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. The OTC benefit provides up to $40 every three months and covers nicotine replacement therapy.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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