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MyTruAdvantage Choice Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MyTruAdvantage Choice Plus (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MyTruAdvantage Choice Plus (PPO) in 2025, please refer to our full plan details page.
MyTruAdvantage Choice Plus (PPO) is a PPO plan offered by SIHO Holding, Inc. available for enrollment in 2025 to people living in Indiana (Partial). This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that MyTruAdvantage Choice Plus (PPO) 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 MyTruAdvantage Choice Plus (PPO).
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 MyTruAdvantage Choice Plus (PPO), 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 a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $4000.00 (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 $4000.00 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:
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Drug Coverage
The MyTruAdvantage Choice Plus (PPO) plan has a $200 deductible for prescription drugs. Once you meet the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $5 copay at a preferred pharmacy and a $15 copay at a standard pharmacy. For specialty tier drugs, there is no copay.
Additional Benefits
The MyTruAdvantage Choice Plus (PPO) plan offers a range of benefits with varying cost-sharing. This plan covers inpatient hospital stays with a copay, along with outpatient services, emergency care, and ambulance services with set copays. Primary care and preventive services are covered, often with no copay, and the plan also includes coverage for hearing, vision, and dental services. Additional benefits include home health, skilled nursing, and cardiac rehabilitation services, all with specific cost-sharing arrangements. The plan also includes coverage for home infusion and dialysis services, along with diagnostic and radiological services. This plan also has an over-the-counter (OTC) benefit, but does not cover many additional services, such as acupuncture or private duty nursing.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $390 for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $35 to $350, observation services with a $325 copay, and ambulatory surgical center services with a $325 copay. Outpatient substance abuse services, including individual and group sessions, have a copay of $35, and outpatient blood services are also covered.
Partial Hospitalization See details
MyTruAdvantage Choice Plus (PPO) covers partial hospitalization with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
The MyTruAdvantage Choice Plus (PPO) plan covers ambulance services, including both ground and air ambulance. Ground ambulance services have a $260 copay, and air ambulance services have a $325 copay. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the MyTruAdvantage Choice Plus (PPO) plan. Emergency Services have a $140 copay, while Urgently Needed Services have a $35 copay. Worldwide Emergency Services has a $90 copay for Worldwide Emergency Coverage, a $35 copay for Worldwide Urgent Coverage, and a $260-$325 copay for Worldwide Emergency Transportation, with a maximum plan benefit coverage of $100,000.
Primary Care See details
The MyTruAdvantage Choice Plus (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, and mental health specialty services with a $35 copay. It also covers other health care professional services with a $35 copay, psychiatric services with a $35 copay, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay ranging from $0 to $35, and opioid treatment program services. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar preventive services, annual physical exams, and other preventive services. The plan also covers kidney disease education services, and the Fitness Benefit, which includes physical and memory fitness. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, 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. Other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered.
Hearing Services See details
Hearing Services are covered, including routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams are covered for one visit per year, and fitting/evaluation for hearing aids is covered for 3 visits with the purchase of hearing aids. Prescription hearing aids are covered for 2 visits per year with a copay between $399 and $899, but hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services, including routine eye exams and eyewear, are covered with no deductible. There is a maximum benefit of $250.00 every year for eye exams. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered, but upgrades are not covered.
Dental Services See details
The MyTruAdvantage Choice Plus (PPO) plan covers dental services, including oral exams, dental X-rays, cleaning, and fluoride treatments with a maximum benefit of $2340 per year for both in and out-of-network services. The plan also includes coverage for restorative services, endodontics, and implant services, but does not cover maxillofacial prosthetics or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the MyTruAdvantage Choice Plus (PPO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the MyTruAdvantage Choice Plus (PPO) plan, but prior authorization is required. The plan has a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered under the MyTruAdvantage Choice Plus (PPO) plan, with Durable Medical Equipment (DME) subject to 20% coinsurance and requiring authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance for Medicare-covered devices and supplies, and Diabetic Therapeutic Shoes/Inserts are covered with a 15% coinsurance; however, Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay required for all diagnostic, therapeutic, and x-ray services. Diagnostic Procedures/Tests have a $25 copay, Lab Services have a $15 copay, Diagnostic Radiological Services have a copay of at most $235, Therapeutic Radiological Services have a copay of at most $60, and Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by the MyTruAdvantage Choice Plus (PPO) plan, with no copay or coinsurance, but 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 MyTruAdvantage Choice Plus (PPO) plan, but 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. The copay is not specified in this snippet.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MyTruAdvantage Choice Plus (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The MyTruAdvantage Choice Plus (PPO) plan does not cover acupuncture, meal benefits, 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, or Self-Directed Personal Assistance Services. This plan offers Over-the-Counter (OTC) Items with a maximum plan benefit coverage amount of $100.00 every three months.
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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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