MercyOne Health Plan Choice (PPO)

Available to residents of Floyd County, IA for 2026. Contract H1846, plan 007, segment 0.

Renewed, service area reduced for 2026. CMS carries this plan forward from 2025.

Plan details

Monthly premium (Part C + D)	$0.00
— medical (Part C) part	$0.00
— drug (Part D) part	$0.00?
Monthly premium with full Extra Help (LIS)	$0.00?
Part B premium reduction (giveback)	$0.70 a month?You must continue to pay your Medicare Part B premium.
In-network out-of-pocket maximum	$4,400.00?
In- and out-of-network out-of-pocket maximum	$4,400.00
Drug deductible	$200.00Tier 1 and 2 exempt
Drug out-of-pocket threshold	$2,100.00
Plan type	PPO?
Contract / plan	H1846-007-0
Offered by	MediGold
Parent organization	Trinity Health Corporation
Formulary drugs	3,507
Formulary exception tier	5?
Pharmacy search	www.thpmedicare.org/mercyone/find-a-provider
Member services	(800)964-4525TTY 711

CMS star ratings

Overall: 4 out of 5 stars for Overall
Health plan (Part C): 4 out of 5 stars for Health plan (Part C)
Drug plan (Part D): 4 out of 5 stars for Drug plan (Part D)

Published per contract — every plan under contract H1846 shares this rating.

Plan health benefits

Service	In-network	Out-of-network?
Doctor visits
Primary care doctor	$0 copay	$15 copay
Specialist	$35 copay	$60 copay
Other health care professional	$0–$35 copay	$15–$60 copay
Additional telehealth services	$0–$35 copay	—
Preventive care
Medicare-covered preventive services	$0 copay	$0 copay
Annual physical exam	$0 copay	$0 copay
Kidney disease education	$0 copay	$0 copay
Glaucoma screening	$0 copay	$0 copay
Diabetes self-management training	$0 copay	$0 copay
Diagnostic tests, labs and imaging
Diagnostic tests and procedures	$30 copay(authorization required)	40% coinsurance
Lab services	$0 copay(authorization required)	$15 copay
Diagnostic radiology (e.g. MRI, CT)	$175 copay	40% coinsurance
Therapeutic radiology	20% coinsurance	40% coinsurance
Outpatient x-rays	$0 copay	40% coinsurance
Emergency and urgent care
Emergency room	$110 copay	—
Urgent care	$35 copay	—
Worldwide emergency coverage	$110 copay	—
Worldwide urgent care	$110 copay	—
Worldwide emergency transportation	$250–$300 copay	—
Hospital care
Inpatient hospital stay	$360 per day for days 1–5; $0 per day for days 6–90(authorization required)	40% coinsurance per stay
Outpatient hospital services	$0–$300 copay	40% coinsurance
Outpatient observation	$350 copay	40% coinsurance
Ambulatory surgical center	$300 copay	40% coinsurance
Outpatient blood services	$0 copay	40% coinsurance
Skilled nursing and home health
Skilled nursing facility	$0 per day for days 1–20; $218 per day for days 21–60; $0 per day for days 61–100	40% coinsurance per stay
Home health care	$0 copay	40% coinsurance
Kidney dialysis	20% coinsurance	40% coinsurance
Rehabilitation
Occupational therapy	$35 copay	$60 copay
Physical therapy and speech-language therapy	$35 copay	$60 copay
Cardiac rehabilitation	$30 copay	40% coinsurance
Pulmonary rehabilitation	$15 copay	40% coinsurance
Mental health and substance use
Inpatient psychiatric hospital stay	$360 per day for days 1–5; $0 per day for days 6–90(authorization required)	40% coinsurance per stay
Outpatient mental health, individual session	$35 copay	$60 copay
Outpatient mental health, group session	$35 copay	$60 copay
Psychiatrist, individual session	$35 copay	$60 copay
Psychiatrist, group session	$35 copay	$60 copay
Partial hospitalization	$50 copay	40% coinsurance
Intensive outpatient program	$50 copay	40% coinsurance
Outpatient substance use, individual session	$35 copay	40% coinsurance
Outpatient substance use, group session	$35 copay	40% coinsurance
Opioid treatment program	$35 copay	$60 copay
Ambulance and transportation
Ground ambulance	$250 copay(authorization required)	$250 copay
Air ambulance	$300 copay(authorization required)	$300 copay
Transportation to plan-approved locations	Not covered	—
Medical equipment and supplies
Durable medical equipment (e.g. wheelchairs, oxygen)	20% coinsurance(authorization required)	40% coinsurance
Prosthetics (e.g. braces, artificial limbs)	20% coinsurance(authorization required)	40% coinsurance
Medical supplies	20% coinsurance(authorization required)	40% coinsurance
Diabetes supplies	$0 copay(authorization required)	40% coinsurance
Diabetic therapeutic shoes or inserts	20% coinsurance(authorization required)	40% coinsurance
Chiropractic, acupuncture and foot care
Chiropractic (Medicare-covered)	$15 copay(authorization required)	$40 copay
Routine chiropractic care	Not covered	—
Acupuncture	$20 copay(authorization required, limits apply)	$60 copay
Foot exams and treatment (Medicare-covered)	$35 copay	$60 copay
Routine foot care	Not covered	—
Dental?
Medicare-covered dental services	$35 copay	40% coinsurance
Preventive dental plan limit	$1,000 plan limit every year	—
Restorative services (fillings, crowns)	50% coinsurance(limits apply)	50% coinsurance
Endodontics (root canals)	70% coinsurance(limits apply)	70% coinsurance
Periodontics (gum disease)	70% coinsurance(limits apply)	70% coinsurance
Dentures and other removable prosthodontics	Optional supplemental benefit (extra premium)	—
Maxillofacial prosthetics	Not covered	—
Implants	Not covered	—
Bridges and other fixed prosthodontics	Optional supplemental benefit (extra premium)	—
Oral and maxillofacial surgery	50% coinsurance(limits apply)	50% coinsurance
Orthodontics	Not covered	—
Adjunctive general services	$0 copay(limits apply)	$0 copay
Vision?
Eye exam (Medicare-covered)	$0–$35 copay	$50 copay
Routine eye exam	$0 copay(limits apply)	$50 copay
Eyewear after cataract surgery (Medicare-covered)	$0 copay(limits apply)	40% coinsurance
Eyewear plan limit	$150 plan limit every year	—
Contact lenses	$0 copay(limits apply)	$0 copay
Eyeglasses (frames and lenses)	$0 copay(limits apply)	$0 copay
Eyeglass lenses	$0 copay(limits apply)	$0 copay
Eyeglass frames	$0 copay(limits apply)	$0 copay
Eyewear upgrades	Not covered	—
Hearing?
Hearing exam (Medicare-covered)	$35 copay	$60 copay
Routine hearing exam	$0 copay(limits apply)	$60 copay
Hearing aid fitting and evaluation	$0 copay	$60 copay
Hearing aids (all types)	$599–$899 copay(limits apply)	$599–$899 copay
Hearing aids, inner ear	Not covered	—
Hearing aids, outer ear	Not covered	—
Hearing aids, over the ear	Not covered	—
Medicare Part B drugs
Part B insulin	$35 copay(authorization required, step therapy may apply)	$35 copay
Chemotherapy and radiation drugs	0%–20% coinsurance(authorization required, step therapy may apply)	0%–30% coinsurance
Other Part B drugs	0%–20% coinsurance(authorization required, step therapy may apply)	0%–30% coinsurance
Other extra benefits?
Over-the-counter (OTC) allowance	$75 allowance every three months	—
Meals after a hospital stay or for a chronic condition	$0 copay	$0 copay
Fitness benefit	$0 copay	$0 copay
Health education	Not covered	—
Nutritional / dietary benefit	Not covered	—
Extra smoking and tobacco cessation counseling	Not covered	—
Enhanced disease management	Not covered	—
Telemonitoring	Not covered	—
Remote access technologies (web/phone, nurse line)	$0 copay	$0 copay
Home and bathroom safety devices	Not covered	—
Counseling services	Not covered	—
In-home safety assessment	Not covered	—
Personal emergency response system (PERS)	Not covered	—
Medical nutrition therapy	Not covered	—
Post-discharge in-home medication reconciliation	Not covered	—
Re-admission prevention	Not covered	—
Wigs for hair loss from chemotherapy	Not covered	—
Weight management programs	Not covered	—
Alternative therapies	Not covered	—
Therapeutic massage	Not covered	—
Adult day health services	Not covered	—
Home-based palliative care	Not covered	—
In-home support services	Not covered	—
Support for caregivers	Not covered	—

In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed; an out-of-network dash means the plan files no separate out-of-network cost for that service. Contact the plan for the full Evidence of Coverage.

Drug tiers — preferred pharmacy, initial coverage

Tier	Cost-sharing
Tier 1	$0.00
Tier 2	$5.00
Tier 3	25%
Tier 4	40%
Tier 5	30%

Rx cost-sharing by coverage phase

Tier	30-day supply			90-day supply
Tier	Preferred	Standard	Mail Order	Preferred	Standard	Mail Order
Initial deductible phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$5.00	$5.00	$0.00	$15.00	$15.00	$0.00
Initial coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$5.00	$5.00	$0.00	$15.00	$15.00	$0.00
Tier 3: Preferred Brand	25%	25%	25%	25%	25%	25%
Tier 4: Non-Preferred Drug	40%	40%	40%	40%	40%	40%
Tier 5: Specialty Tier	30%	30%	30%	n/a	n/a	n/a
Catastrophic coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 3: Preferred Brand	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 4: Non-Preferred Drug	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 5: Specialty Tier	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00

Also available in 56 other IA counties

Benefits in plain text

MercyOne Health Plan Choice (PPO) (H1846-007-0) is a 2026 PPO Medicare Advantage plan offered by MediGold, available to residents of Floyd County, IA.

The monthly premium is $0.00 (Part C and Part D together).

The plan reduces the member's Medicare Part B premium by $0.70 a month (a "giveback"); the Part B premium itself must still be paid.

With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.

Its in-network out-of-pocket maximum is $4,400.00.

The combined in- and out-of-network out-of-pocket maximum is $4,400.00.

The drug deductible is $200.00. Tier 1 and 2 exempt.

The plan's formulary lists 3,507 drugs.

At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $5.00; tier 3: 25%; tier 4: 40%; tier 5: 30%.

CMS gives the plan's contract (H1846) an overall rating of 4 out of 5 stars.

Email a copy of the plan benefit details

Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.