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American Health Advantage of Indiana (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for American Health Advantage of Indiana (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on American Health Advantage of Indiana (HMO I-SNP) in 2025, please refer to our full plan details page.
American Health Advantage of Indiana (HMO I-SNP) is a HMO I-SNP plan offered by Mitchell Family Office available for enrollment in 2025 to people living in Indiana. The overall rating for this plan is not yet available for 2025.
It's important to know that American Health Advantage of Indiana (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
American Health Advantage of Indiana (HMO I-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about American Health Advantage of Indiana (HMO I-SNP).
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 American Health Advantage of Indiana (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.60. 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 $590.00 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 $9350.00 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:
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Drug Coverage
The American Health Advantage of Indiana (HMO I-SNP) plan has a $590 deductible for prescription drugs. After you meet the deductible, you will pay the specified costs for your drugs. The plan's formulary provides details on specific drug coverage. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). If you have LIS, your Part D premium is $49.60.
Additional Benefits
The American Health Advantage of Indiana (HMO I-SNP) plan offers a range of benefits, including no copay for primary care, preventive services, and home health services. This plan covers outpatient services, partial hospitalization, and ambulance services, all with a 20% coinsurance. Hearing and vision services are also included, with hearing exams at 20% coinsurance, and eye exams with no copay. This plan provides coverage for a variety of other services, such as dental services with a 20% coinsurance, and home infusion services. Diagnostic and radiological services have a coinsurance of at most 20%, and skilled nursing facility (SNF) services have no copay for days 1-100. However, some services like cardiac rehabilitation and certain "other services" are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days, non-Medicare-covered stays, and upgrades for acute and psychiatric care are not covered. The copay for these services is defined by Medicare.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services and ambulatory surgical center services, each with a 20% coinsurance, as well as outpatient substance abuse services, individual sessions, and group sessions, each with a 20% coinsurance, but outpatient blood services are not covered. Outpatient hospital services and observation services both require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered by the American Health Advantage of Indiana (HMO I-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the American Health Advantage of Indiana (HMO I-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay, with 34 one-way trips covered per year. 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 by American Health Advantage of Indiana (HMO I-SNP), but Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered. Emergency Services and Urgently Needed Services have a 20% coinsurance, and both have no copay.
Primary Care See details
The American Health Advantage of Indiana (HMO I-SNP) plan covers primary care physician services with no copay, and covers chiropractic services with 20% coinsurance. Occupational therapy services are covered, with a coinsurance between 0% and 20%, and physician specialist services have a coinsurance between 0% and 20%. Mental health specialty services, psychiatric services, and physical/speech therapy services are covered with 0-20% coinsurance, and additional telehealth benefits and opioid treatment program services are covered with no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, Kidney Disease Education Services, and Other Preventive Services. Other preventive services include coverage for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services include coverage for hearing exams with a coinsurance of 20% and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum benefit of $500 per year, and no copay for Prescription Hearing Aids (all types).
Vision Services See details
The American Health Advantage of Indiana (HMO I-SNP) plan covers vision services, including eye exams and eyewear. Eye exams have a 20% coinsurance for routine eye exams, and no copay. Eyewear has a 20% coinsurance, and no copay, with a combined maximum benefit of $300 per year.
Dental Services See details
Dental Services are partially covered by American Health Advantage of Indiana (HMO I-SNP), with Medicare Dental Services covered at 20% coinsurance. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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 American Health Advantage of Indiana (HMO I-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by American Health Advantage of Indiana (HMO I-SNP). Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services has no copay and Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the American Health Advantage of Indiana (HMO I-SNP) plan with no copay and no 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 American Health Advantage of Indiana (HMO I-SNP) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by American Health Advantage of Indiana (HMO I-SNP) with prior authorization. There is no copay for days 1-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter (OTC) items, 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. This plan does not require authorization or referrals for additional services.
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