2025 IU Health Medicare Certification Exam

The quarterly OTC benefit is $40 on all plans in 2025.

Members with high-cost drugs will be able to spread their costs out monthly by being enrolled in the M3P program.

All plans with RX coverage provide Insulins for a $35 copay.

The Flex Network (HMO-POS) plan works just like a PPO plan with NO referrals required and unlimited out of network coverage.

The Flex Network (HMO-POS) plan has a $0 premium and will be available in Monroe County in 2025.

The dental benefit on all plans includes $1,500 of embedded dental coverage including preventive and basic services.

When adding a dental buy-up option, dental implants are not a covered benefit for 2025 and the total dental benefit for the member will be the amount of the plan selected plus the $1,500 embedded amount.

New for 2025, the Flex Network (HMO-POS) plan and the $0 Preferred (HMO) plan will both be offered in all of the same counties.

The drug MOOP will go from $8,000 to $2,000 in 2025 and the coverage gap is eliminated.

All plans include up to 42 meals delivered upon hospital discharge

All plans with RX coverage provide 30-day Tier 6 (Select Care) and Tier 1 (Preferred Generic) at retail pharmacies for $0 copay (excluding Choice (HMO-POS)).

The 2025 Flex Network (HMO-POS) has $0 PCP visits in-network and $25 for out-of-network providers.

The travel benefit on all segments of Select Plus (HMO), $0 Preferred (HMO), Flex Network (HMO-POS), and Kidney Care (HMO), when activated, allows for claims from any out of state Medicare approved provider in the U.S. to be treated as an in-network claim.

All IU Health Medicare Advantage Plans offer a transportation benefit.

All IU Health Medicare Advantage Plans with prescription benefits have a $0 RX deductible.

The Preferred Retail Pharmacy Network will go away in 2025.

The Flex (HMO-POS) and $0 Preferred (HMO) plans have a $70 Part B premium reduction that will either reduce the amount of Part B premium being deducted from Social Security or if they pay quarterly, they will get a credit on their quarterly bill.

The Part B premium reduction is not immediate; it can take up to 90 days for Social Security to set it up like it does when setting up Social Security premium deductions.

In order to be eligible for extra benefits (SSBCI program) in the Kidney Care (HMO) plan, you must be under the care of an IU Health Physicians Kidney Health provider and actively participate in their care management program. Members in the SSBCI program have their benefits enhanced with $0 copay for dialysis, $0 copay for visits to IU Health Physicians Kidney Health Nephrologists, enhanced transportation, and renal-diet meals to help manage a chronic condition.

The Kidney Care (HMO) plan is primarily designed for people with Chronic Kidney Disease (CKD) stages 3-5 and ESRD / kidney failure on dialysis.