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IU Health Plans Medicare Select Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for IU Health Plans Medicare Select Plus (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 Plus (HMO) in 2025, please refer to our full plan details page.
IU Health Plans Medicare Select Plus (HMO) is a HMO plan offered by Indiana University Health available for enrollment in 2025 to people living in Indianapolis Metro Area and Surrounding 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 Plus (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 IU Health Plans Medicare Select Plus (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 Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $55.00. 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 Maximum Out-Of-Pocket cost of $5150.00 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 Plus (HMO)
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Drug Coverage
The IU Health Plans Medicare Select Plus (HMO) plan has an enhanced alternative drug benefit with no deductible. During the initial coverage phase, you will pay a copay or coinsurance based on the drug tier and pharmacy used. For example, a standard generic drug has a $3.00 copay, while preferred brand drugs have a 50% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered Part D 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 Select Plus (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services, including hospital and ambulatory surgical center services, have copays ranging from $295 to $350. Emergency services and primary care visits also have copays, and the plan covers hearing, vision, and dental services. This plan includes coverage for home health, skilled nursing facilities, and ambulance services, with some services requiring prior authorization. Additionally, you'll find coverage for preventive services, medical equipment, and diagnostic and radiological services with copays or coinsurance. There is also coverage for outpatient substance abuse and mental health services, as well as home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $395 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, there is a $380 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services and Observation Services, each with a $350 copay. Ambulatory Surgical Center (ASC) Services have a $295 copay. Outpatient Substance Abuse Services are covered, with individual and group sessions having a copay between $35.00 and $35.00. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $295 copay. Transportation Services to a plan-approved health-related location are covered for 24 one-way trips per year via bus/subway, medical transport, or other means. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the IU Health Plans Medicare Select Plus (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $45 copay, and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The IU Health Plans Medicare Select Plus (HMO) plan covers primary care physician services with a copay between $0 and $10. Chiropractic services have a $20 copay, and occupational therapy services have a $25 copay. Physician specialist services are covered with a $35 copay, and mental health specialty services have a $35 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits are available for many services, and opioid treatment program services have a $35 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The IU Health Plans Medicare Select Plus (HMO) plan covers preventive services, including Medicare-covered services with prior authorization, annual physical exams, health education, wigs for hair loss due to chemotherapy, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, and a fitness benefit. The plan does not cover in-home safety assessment, 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 smoking cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, or counseling services.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams are covered for one visit per year. Prescription hearing aids are covered with a copay between $499 and $999 for two visits per year, while inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
The IU Health Plans Medicare Select Plus (HMO) plan covers vision services, including eye exams with a $35 copay, and eyewear with a combined maximum benefit of $250 every two years. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered, with limitations on the number of pairs or items allowed. Upgrades are not covered.
Dental Services See details
The IU Health Plans Medicare Select Plus (HMO) plan covers dental services, with a maximum benefit of $1,500 per year. Oral exams, dental x-rays, prophylaxis (cleaning), restorative services, and oral and maxillofacial surgery are covered, with no coinsurance for oral exams, dental x-rays, prophylaxis (cleaning), and adjunctive general services, but a 50% coinsurance for restorative services and oral and maxillofacial surgery. Fluoride treatment, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by IU Health Plans Medicare Select Plus (HMO), including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the IU Health Plans Medicare Select Plus (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment benefits are covered, including durable medical equipment with 20% coinsurance and no copay, prosthetic devices with 20% coinsurance, and medical supplies with 20% coinsurance and no copay. Diabetic equipment is covered, but diabetic supplies are not covered, while diabetic therapeutic shoes/inserts are covered with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the IU Health Plans Medicare Select Plus (HMO) plan. Diagnostic Procedures/Tests and Therapeutic Radiological Services have a coinsurance of up to 20%, while Lab Services have no copay, and 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 Plus (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of 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 are not covered. The copay for these services is described elsewhere in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The IU Health Plans Medicare Select Plus (HMO) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $40 every three months, and covers meal benefits that require prior authorization. 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.
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