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IU Health Plans Medicare Kidney Care (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for IU Health Plans Medicare Kidney Care (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 Kidney Care (HMO) in 2025, please refer to our full plan details page.
IU Health Plans Medicare Kidney Care (HMO) is a HMO plan offered by Indiana University Health available for enrollment in 2025 to people living in State of Indiana - 9 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 Kidney Care (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 Kidney Care (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 Kidney Care (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.
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 $3400.00 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 Kidney Care (HMO)
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Drug Coverage
The IU Health Plans Medicare Kidney Care (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, standard generic drugs have a $3.00 copay, while preferred brand drugs have a 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase. In this phase, you'll pay nothing for covered Part D drugs.
Additional Benefits
The IU Health Plans Medicare Kidney Care (HMO) plan offers coverage for various healthcare services with specific cost-sharing arrangements. This plan includes coverage for inpatient and outpatient hospital services, with copays ranging from $35 to $395 depending on the service. You will also have access to services like primary care, hearing, vision, and dental, as well as home health services, and skilled nursing facilities, with varying copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, but require prior authorization. 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 $395 copay for days 1-6, and no copay for days 7-90. Additional days and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered, and non-Medicare covered stays for Inpatient Hospital-Acute and Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for all 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 Individual and Group Sessions for Outpatient Substance Abuse have a copay between $35.00 and $35.00. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the IU Health Plans Medicare Kidney Care (HMO) plan with a $55 copay, and prior authorization is required.
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 copay of $295.00 each, and Transportation Services to a plan-approved health-related location are covered for up to 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, including Worldwide Emergency Coverage and Urgent Coverage, are covered under the IU Health Plans Medicare Kidney Care (HMO) plan. Emergency Services have a $140 copay and no coinsurance, Urgently Needed Services have a $45 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The IU Health Plans Medicare Kidney Care (HMO) plan covers primary care physician services with a copay between $0 and $10, chiropractic services with a $20 copay, occupational therapy with a $25 copay, and physician specialist services with a $35 copay. Mental health and psychiatric services, as well as opioid treatment program services, have a $35 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits are also covered, and podiatry services are not covered.
Preventive Services See details
The IU Health Plans Medicare Kidney Care (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. Some additional preventive services are not covered, including 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 modifications, and counseling services.
Hearing Services See details
Hearing services include routine hearing exams with a $35 copay, fitting/evaluation for hearing aids, and prescription hearing aids. Prescription hearing aids have a copay between $499 and $999, depending on the type, and are limited to two per year. Prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include 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 covered, and upgrades are not covered.
Dental Services See details
The IU Health Plans Medicare Kidney Care (HMO) plan covers a variety of dental services, including oral exams and dental x-rays with no coinsurance, and also covers prophylaxis (cleaning) with no coinsurance. Restorative Services and Oral and Maxillofacial Surgery are covered with a 50% coinsurance, while 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, while 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 by the IU Health Plans Medicare Kidney Care (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered by the IU Health Plans Medicare Kidney Care (HMO) plan, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, while 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 at most 20%, Lab Services with no copay, Diagnostic Radiological Services with a coinsurance of at most 20% and no minimum coinsurance, Therapeutic Radiological Services with a coinsurance of at most 20% and a minimum coinsurance of 20%, and Outpatient X-Ray Services with a $30 copay.
Home Health Services See details
Home Health Services are covered by the IU Health Plans Medicare Kidney Care (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 technically covered, but the plan does not cover any Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some Cardiac Rehabilitation Services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. You will have no copay for days 1-20, and a $214 copay per day for days 21-100.
Other Services See details
The IU Health Plans Medicare Kidney Care (HMO) plan 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. The plan also covers a meal benefit, but prior authorization is required.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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