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IU Health Plans Medicare Flex Network (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for IU Health Plans Medicare Flex Network (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 Flex Network (HMO-POS) in 2025, please refer to our full plan details page.
IU Health Plans Medicare Flex Network (HMO-POS) is a HMO-POS 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 Flex Network (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 Flex Network (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 Flex Network (HMO-POS), 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 combined Maximum Out-Of-Pocket cost of $10000.00 (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 $10000.00 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 Flex Network (HMO-POS)
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Drug Coverage
The IU Health Plans Medicare Flex Network (HMO-POS) plan has an "Enhanced Alternative" drug benefit. This plan has no deductible. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, a standard generic drug has a $47 copay. In the catastrophic coverage phase, you will pay nothing for Medicare Part D covered drugs after your yearly out-of-pocket drug costs reach $2000.
Additional Benefits
The IU Health Plans Medicare Flex Network (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, but outpatient services, like primary care visits, have copays ranging from $15 to $30. The plan also provides coverage for services such as ambulance, vision, dental, and home health, with specific copays or coinsurance depending on the service. This plan includes coverage for hearing exams and hearing aids, as well as diagnostic and radiological services with coinsurance. It also offers benefits like transportation services, and an allowance for over-the-counter items. However, some services are not covered, including certain types of hearing aids, cardiac rehabilitation, and additional personal care services.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you'll pay a $395 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you'll pay 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 for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient hospital and observation services have a $350 copay, ambulatory surgical center services have a $295 copay, and outpatient substance abuse individual and group sessions have a copay between $30 and $30. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the IU Health Plans Medicare Flex Network (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $55.
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 plan-approved health-related locations are covered for 24 one-way trips per year.
Emergency Services See details
Emergency Services are covered, with a $125 copay and no coinsurance. Urgently Needed Services are covered, with a $45 copay and no coinsurance. Worldwide Emergency Services are covered, with a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The IU Health Plans Medicare Flex Network (HMO-POS) plan covers primary care physician services, 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, physical therapy and speech-language pathology services with a $15 copay, and opioid treatment program services with a $30 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including annual physical exams, health education, wigs for hair loss related to chemotherapy, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, and fitness benefits. 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 Services include routine hearing exams with a $30 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $499 and $999, though inner ear, outer ear, and over the ear hearing aids are not covered; OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams with a $30 copay, and routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered. Eyewear has a combined maximum plan benefit coverage of $250 every two years, and upgrades are not covered.
Dental Services See details
The IU Health Plans Medicare Flex Network (HMO-POS) plan covers various dental services, including oral exams, dental X-rays, prophylaxis (cleaning), restorative services, and adjunctive general services. Oral exams, dental X-rays, and prophylaxis (cleaning) 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, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the IU Health Plans Medicare Flex Network (HMO-POS) plan with a 20% coinsurance.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Medical Supplies requires authorization. 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, including Diagnostic Procedures/Tests with a coinsurance of up to 20%, Lab Services with no copay, Diagnostic Radiological Services with a coinsurance of 0%, Therapeutic Radiological Services with a coinsurance of up to 20%, and Outpatient X-Ray Services with a $15 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the IU Health Plans Medicare Flex Network (HMO-POS) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the IU Health Plans Medicare Flex Network (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the IU Health Plans Medicare Flex Network (HMO-POS) plan, but require prior authorization. There is 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 Flex Network (HMO-POS) plan's Other Services benefit covers Over-the-Counter (OTC) items with a maximum benefit coverage amount of $40.00 every three months. However, 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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