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Trinity Health Plan of Michigan Cash Back (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Trinity Health Plan of Michigan Cash Back (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Trinity Health Plan of Michigan Cash Back (HMO) in 2025, please refer to our full plan details page.
Trinity Health Plan of Michigan Cash Back (HMO) is a HMO plan offered by Trinity Health Corporation available for enrollment in 2025 to people living in Select Counties in Michigan. The overall rating for this plan is not yet available for 2025.
It's important to know that Trinity Health Plan of Michigan Cash Back (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 Trinity Health Plan of Michigan Cash Back (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 Trinity Health Plan of Michigan Cash Back (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 $161.80. 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 a $350.00 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 Maximum Out-Of-Pocket cost of $6700.00 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 Trinity Health Plan of Michigan Cash Back (HMO)
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Drug Coverage
The Trinity Health Plan of Michigan Cash Back (HMO) plan has a $350 deductible for prescription drugs. During the initial coverage phase, after the deductible is met, you'll pay varying costs depending on the drug tier and pharmacy type. For example, you may have a $5 copay for preferred generic drugs at a standard pharmacy or a 25% coinsurance for standard generic drugs at a standard or mail-order pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your Part D costs will be $0.
Additional Benefits
The Trinity Health Plan of Michigan Cash Back (HMO) offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, but many other services have no copay, including primary care visits, preventive services, routine vision exams, and dental cleanings. Outpatient services, hearing exams, and prescription hearing aids have copays, while services like ambulance, emergency care, and diagnostic procedures have varying copays and coinsurance. The plan also provides additional benefits like hearing, vision, and dental coverage. It covers home health services with no copay, and Skilled Nursing Facility (SNF) stays have no copay for the first 20 days. Additionally, the plan includes coverage for acupuncture, over-the-counter items, and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital services include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization; for the first 5 days, the copay is $395 per day, and there is no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $350, and observation services and outpatient blood services have no copay. Ambulatory Surgical Center (ASC) Services have a $350 copay, and outpatient substance abuse services have a $40 copay per session.
Partial Hospitalization See details
Partial Hospitalization is covered by the Trinity Health Plan of Michigan Cash Back (HMO) with a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Trinity Health Plan of Michigan Cash Back (HMO). Ground ambulance services have a $250 copay, while air ambulance services have a $300 copay, and both have no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Trinity Health Plan of Michigan Cash Back (HMO). Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services has a $35 copay, and Worldwide Emergency Transportation has a $250-$300 copay.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $10 copay, Occupational Therapy Services with a $40 copay, Physician Specialist Services with a $40 copay, and Mental Health Specialty Services with a $40 copay for individual and group sessions. Also included are Podiatry Services (not covered), Other Health Care Professional services (copay between $0 and $40), Psychiatric Services (with a $40 copay for individual and group sessions), Physical Therapy and Speech-Language Pathology Services with a $40 copay, Additional Telehealth Benefits (copay between $0 and $40), and Opioid Treatment Program Services with a $40 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, Annual Physical Exams with no copay, and Additional Preventive Services, including Fitness Benefits and Remote Access Technologies, with no copay. Other services such as 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, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $599 and $899, while prescription hearing aids for inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0 - $40, routine eye exams with no copay, and eyewear. Eyewear includes contact lenses, eyeglasses (lenses and frames), and eyeglass lenses, all with no copay, and eyeglass frames with no copay, but upgrades are not covered.
Dental Services See details
The Trinity Health Plan of Michigan Cash Back (HMO) plan covers dental services, including oral exams and dental x-rays with no copay, and prophylaxis (cleaning) and fluoride treatments with no copay. Restorative services and oral and maxillofacial surgery are covered with 50% coinsurance, and a $1,000 annual maximum. Endodontics, periodontics, prosthodontics, and implant services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Trinity Health Plan of Michigan Cash Back (HMO). 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 Trinity Health Plan of Michigan Cash Back (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment, including Diabetic Supplies with no copay and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic procedures/tests have a $40 copay, and diagnostic radiological services have a copay of at most $350.00, therapeutic radiological services have a copay of at most $60, and outpatient X-ray services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the Trinity Health Plan of Michigan Cash Back (HMO) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Trinity Health Plan of Michigan Cash Back (HMO), but the plan does not provide details on the cost sharing for this benefit. However, Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Trinity Health Plan of Michigan Cash Back (HMO) plan. There is no copay for days 1-20 and days 56-100, but there is a $214 copay for days 21-55.
Other Services See details
The Trinity Health Plan of Michigan Cash Back (HMO) plan covers acupuncture with a $20 copay per visit, up to 6 treatments per year, and also covers over-the-counter (OTC) items with no copay, up to a $50 maximum benefit every three months, including nicotine replacement therapy and naloxone. The plan also offers a meal benefit with no copay for a chronic illness. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and many other services are not covered.
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