IU Health Plans Medicare Select (HMO)
Medicare Plan Details
2021 Plan
Monthly Premium
| (select county for price) |
by Indiana University Health Plans - Medicare
Additional Coverage
Hearing
Vision
Dental
Overall Government Star Rating
4.5out of 5 stars
State: Indiana
Select your county to view the price for this plan
Plan Type
Medicare Advantage (Part C)
Medicare Advantage combines Part A and Part B. This plan = Part A + Part B
Plan Details
Medical Benefits
Doctor Services
$0 copay
$40 copay per visit
Tests, labs, & imaging
20% coinsurance
$10 copay
20% coinsurance
$25 copay
$90 copay per visit (always covered)
$65 copay per visit (always covered)
Hospital Services
$335 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 7 through 90
$300 copay per visit
Skilled nursing facility
$0 per day for days 1 through 20
$184 per day for days 21 through 100
$184 per day for days 21 through 100
Preventive services
$0 copay
Ambulance
$275 copay
Therapy services
$40 copay
$40 copay
Mental health services
$40 copay
$40 copay
$40 copay
$40 copay
Opioid treatment services
Covered
Other services
20% coinsurance per item
20% coinsurance per item
$0 copay
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Part B Drugs
20% coinsurance
20% coinsurance
Extra Benefits
Hearing
$40 copay
$0 copay
$699-999 copay
Preventive Dental
0-50% coinsurance
0-50% coinsurance
Not covered
0-50% coinsurance
Comprehensive dental
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Vision
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
Not covered
Other benefits
Limited coverage
Limited coverage
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
Health Plan Star Ratings
(government star ratings are out of 5 stars)
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