MercyOne Health Plan No Premium (HMO) 2025 Plan Details for Monona County, Iowa Residents
MercyOne Health Plan No Premium (HMO) 2025 Plan Details for Monona County, Iowa Residents
Choosing the right Medicare Advantage plan in Monona County is crucial for your healthcare needs in 2025. With MercyOne Health Plan No Premium (HMO) as one of the options, you can compare it side-by-side with other available plans to find the best fit. Whether you prefer enrolling online or seeking advice from a licensed agent, we’ve made the process simple and straightforward.
MercyOne Health Plan No Premium Overview
Plan ID H3668-025-0 Overview | |
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Health Plan ID: | H3668-025-0 |
Medicare Advantage Plan Type: | Local HMO |
Plan Year: | 2024 |
Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | $3,500 |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
Part D Gap Coverage: | Yes |
Supplemental Benefits: | Vision, Hearing |
Availability: | Monona County, IA |
Insured By: | MediGold |
Explore MercyOne Health Plan No Premium Benefits
MercyOne Health Plan No Premium is a Medicare Advantage Prescription Drug (MAPD) Health Maintenance Organization (HMO) plan offering complete healthcare coverage. With a monthly premium of $0.00, this plan provides all the benefits of Medicare Part A and Part B, plus additional services like prescription drug coverage. There is no annual deductible. Cost sharing begins with your first prescription. As an HMO, you’ll generally need to use network providers, except in emergencies.
MercyOne Health Plan No Premium also offers financial protection through its annual maximum out-of-pocket (MOOP) limit of $3,500. Once you reach this limit, the plan covers 100% of your in-network healthcare costs for the remainder of the year. This feature makes MercyOne Health Plan No Premium a solid option for those seeking both medical and prescription drug coverage with clear and predictable costs.
We're Here to Help You Enroll |
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Cost-Sharing Overview
MercyOne Health Plan No Premium has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H3668-025-0.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 Copay |
Specialist: | $30 Copay |
Wellness & Preventive Programs: | None |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $30 Copay |
Routine Foot Care: | Not Covered |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $20 Copay Prior Authorization Required |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | $90 Copay |
Urgent care: | $30 Copay |
Ground ambulance: | $240 Copay |
Inpatient hospital care: | $325.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient hospital care: | $275 Copay |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $203.00 per day for days 21 through 56 $0.00 per day for days 57 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $30 Copay |
Outpatient group therapy: | $30 Copay |
Inpatient psychiatric hospital care: | $325.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient group therapy: | $30 Copay |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $30 Copay |
Occupational therapy: | $30 Copay |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | $0 Copay Prior Authorization Required |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $160 Copay Prior Authorization Required |
Lab services: | $0 Copay Prior Authorization Required |
Outpatient x-rays: | $0 Copay Prior Authorization Required |
Diagnostic tests and procedures: | $30 Copay Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Most preventive services are covered 100% by MercyOne Health Plan No Premium as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that MediGold offers with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | $0 Copay Limitations Apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay |
Vision | Maximum vision benefit: | $200.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
Routine eye exam (In-Network) | $0 Copay |
Contact lenses (In-Network) | $0 Copay |
Additional Benefits
None specified.
Part D Prescription Drug Costs & Benefits
MercyOne Health Plan No Premium includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
While the prescription drug plan (Part D) premium is included in the overall plan cost, some plans may have additional costs or provide assistance through the Low-Income Subsidy (LIS) program. Also known as Extra Help, LIS is a Social Security program that assists individuals with limited income and resources in reducing or eliminating Part D expenses.
The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $0.00 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $0.00 |
Part D Premium with Full LIS Assistance: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. You must pay this amount at the pharmacy before MediGold begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, MercyOne Health Plan No Premium has out-of-pocket costs that you must pay when you pick up your prescriptions.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | N/A | $0.00 copay |
2 (Generic) | N/A | $0.00 copay |
3 (Preferred Brand) | N/A | $45.00 copay |
4 (Non-Preferred Drug) | N/A | $95.00 copay |
5 (Specialty Tier) | N/A | 33% |
How CMS Star Ratings Guide Your Choice
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
Who Can Enroll in MercyOne Health Plan No Premium?
To qualify for enrollment in MercyOne Health Plan No Premium, you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
- Not have End-Stage Renal Disease (ESRD), except under certain conditions.
If you fulfill these criteria, you can enroll in MercyOne Health Plan No Premium and enjoy the extensive healthcare benefits it offers.
When Can I Enroll in MercyOne Health Plan No Premium?
Understanding the right time to enroll in MercyOne Health Plan No Premium is crucial. Here are the key enrollment periods:
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare starts three months before your 65th birthday and lasts until three months after your birthday month.
- Annual Enrollment Period (AEP): Occurring annually from October 15 to December 7, the AEP allows you to enroll in, switch, or drop a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31 each year, the MA OEP gives you the chance to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing other coverage, may make you eligible for a SEP, allowing you to adjust your plan outside the usual periods.
Not sure when to enroll? Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) to speak with a licensed insurance agent who can guide you through your options.
How to Sign Up for MercyOne Health Plan No Premium
Getting started with MercyOne Health Plan No Premium is simple. Here are your options:
- Online Enrollment: Easily enroll online using a secure form. Visit the MedicareEnrollment.com enrollment page and follow the steps to complete your enrollment.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711). A licensed insurance agent will guide you through the process and answer any questions.
- Through Medicare.gov: Enroll through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the instructions to join a Medicare Advantage plan.
- Directly with the Plan: You can also enroll directly with MercyOne Health Plan No Premium. The plan's contact information is available below in the "Contact" section.
Be sure to enroll during the appropriate period to ensure your coverage begins without delay.
Contact MediGold
Website: | http://www.MediGold.com |
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Formulary: | http://www.MediGold.com |
Pharmacy: | MediGold Pharmacy Page |
New Members: | (800)964-4525 |
TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, you can do so on the Social Security Administration website. For more information about the Medicare Part C program, visit the official Medicare website or call 1-800-MEDICARE.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
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