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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. After 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 preferred pharmacies, $15 at standard pharmacies, and $8 via mail order. For specialty tier drugs, there is no copay.
Additional Benefits
The MyTruAdvantage Choice Plus (PPO) plan offers a wide range of benefits, including inpatient and outpatient hospital services, with varying copays. You will have no copay for primary care physician visits, and preventive services are covered with no copay. The plan also provides coverage for vision, dental, and hearing services, with specific allowances and copays for each. This plan includes coverage for emergency services, ambulance, and home health services, with specific copays and coinsurance amounts. Other notable benefits include coverage for medical equipment, diagnostic and radiological services, and skilled nursing facility services. Additionally, the plan offers over-the-counter item coverage.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $390 for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital Psychiatric are not covered, and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services, including all Outpatient Hospital Services, Observation Services, and Ambulatory Surgical Center (ASC) Services, are covered with copays ranging from $35 to $350. Outpatient Substance Abuse Services are covered with a $35 copay for both individual and group sessions, and Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the MyTruAdvantage Choice Plus (PPO) plan, with a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MyTruAdvantage Choice Plus (PPO) plan. Ground Ambulance Services have a $260 copay, while Air Ambulance Services have a $325 copay, with no coinsurance for either service. Transportation Services to any health-related location 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, and no coinsurance; Urgently Needed Services have a $35 copay, and no coinsurance; Worldwide Emergency Coverage has a $90 copay, and no coinsurance; Worldwide Urgent Coverage has a $35 copay, and no coinsurance; and Worldwide Emergency Transportation has a copay between $260 and $325, and no coinsurance.
Primary Care See details
The MyTruAdvantage Choice Plus (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay for Routine Care, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a $35 copay, and Mental Health Specialty Services with a $35 copay for both individual and group sessions. This plan also covers Physical Therapy and Speech-Language Pathology Services with a $35 copay, Additional Telehealth Benefits with a copay between $0 and $35, and Opioid Treatment Program Services.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services with no copay. Additional services are covered, but health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 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. Fitness benefit is covered, and includes physical and memory fitness. Kidney Disease Education Services are covered, as are other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit.
Hearing Services See details
Hearing services are covered, including routine hearing exams with one visit allowed per year, and fitting/evaluation for hearing aids with three visits included with hearing aid purchase. Prescription hearing aids are covered with a copay between $399 and $899, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. This plan offers a maximum of $250.00 per year for eye exams and does not have a deductible for any vision services.
Dental Services See details
Dental Services are covered, with a maximum benefit of $2340 per year for both in-network and out-of-network services. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered with a limited number of visits per year, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the MyTruAdvantage Choice Plus (PPO) plan. 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 under the MyTruAdvantage Choice Plus (PPO) plan, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment is covered under the MyTruAdvantage Choice Plus (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic therapeutic shoes/inserts have a 15% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic procedures/tests have a copay of $25, lab services have a copay of $15, diagnostic radiological services have a copay of up to $235, therapeutic radiological services have a copay of at least $60, and outpatient X-ray services have a copay of $30.
Home Health Services See details
Home Health Services are covered by the MyTruAdvantage Choice Plus (PPO) plan with no copay and no coinsurance, but require authorization. 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 Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some Cardiac and Pulmonary Rehabilitation Services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by MyTruAdvantage Choice Plus (PPO) with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are partially covered, with 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, and Self-Directed Personal Assistance Services not covered. Over-the-counter items are covered with a maximum plan benefit of $100.00 every three months.
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