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IU Health Plans Medicare $0 Preferred (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for IU Health Plans Medicare $0 Preferred (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 $0 Preferred (HMO) in 2025, please refer to our full plan details page.
IU Health Plans Medicare $0 Preferred (HMO) is a HMO plan offered by Indiana University Health available for enrollment in 2025 to people living in State of Indiana - 38 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 $0 Preferred (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 $0 Preferred (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 $0 Preferred (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 $70.00. 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.
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 $4155.00 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 IU Health Plans Medicare $0 Preferred (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy. For example, Tier 1 and Tier 2 drugs have copays of $3 and $47, respectively, at standard pharmacies. For brand name and non-preferred drugs, you will pay coinsurance, which is a percentage of the drug's cost. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs.
Additional Benefits
The IU Health Plans Medicare $0 Preferred (HMO) plan offers comprehensive coverage with a focus on low-cost access to care. The plan features no copays for primary care physician visits, home health services, and many preventive services. You will have copays for other services, such as a $125 copay for emergency services, and a $395 copay for inpatient hospital stays. The plan also includes benefits for hearing, vision, and dental services. Hearing services include hearing exams, and coverage for hearing aids with a copay between $499 and $999. Vision services include eye exams, and coverage for eyewear with a combined maximum benefit of $250 every two years. Dental services include oral exams, dental X-rays, and cleaning with no coinsurance, while restorative services and oral and maxillofacial surgery have a 50% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $395 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $380 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services, each with a $350 copay, Ambulatory Surgical Center (ASC) Services with a $295 copay, and Individual and Group Sessions for Outpatient Substance Abuse, both with a copay between $30 and $30. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the IU Health Plans Medicare $0 Preferred (HMO) plan with a $55 copay. Prior authorization is required for this benefit.
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.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the IU Health Plans Medicare $0 Preferred (HMO) plan. Emergency Services has a $125 copay, while Urgently Needed Services has a $45 copay; both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $125 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $15 copay, Physician Specialist Services with a $30 copay, Mental Health Specialty Services with a $30 copay for individual and group sessions, Podiatry Services are not covered, Other Health Care Professional services with a $30 copay, Psychiatric Services with a $30 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $15 copay, Additional Telehealth Benefits, and Opioid Treatment Program Services with a $30 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
The IU Health Plans Medicare $0 Preferred (HMO) plan covers preventive services including Medicare-covered services with prior authorization, annual physical exams, health education, wigs for hair loss related to chemotherapy, fitness benefits, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Some services are not covered, including 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 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.
Hearing Services See details
Hearing services include hearing exams with a $30 copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a copay between $499 and $999 for all types; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered. Routine hearing exams are covered for 1 visit every year.
Vision Services See details
Vision services include eye exams with a $30 copay, and coverage for 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 $0 Preferred (HMO) plan covers dental services including oral exams, dental X-rays, prophylaxis (cleaning), restorative services, adjunctive general services, and oral and maxillofacial surgery. Oral exams, dental X-rays, prophylaxis (cleaning), and adjunctive general services have no coinsurance, while restorative services and oral and maxillofacial surgery have a 50% coinsurance. Fluoride treatment, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the IU Health Plans Medicare $0 Preferred (HMO) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs, and coinsurance between 0-20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the IU Health Plans Medicare $0 Preferred (HMO) plan. You are responsible for 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the IU Health Plans Medicare $0 Preferred (HMO) plan. Diagnostic Procedures/Tests and Therapeutic Radiological Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have a coinsurance of at least 0%. Lab services have no copay, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the IU Health Plans Medicare $0 Preferred (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 not covered by the IU Health Plans Medicare $0 Preferred (HMO) plan. Although the plan covers Cardiac Rehabilitation Services, none of the sub-services (including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services) are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The "Other Services" benefit covers over-the-counter items with a maximum benefit of $40 every three months, and meal benefits for chronic illnesses with prior authorization. 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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