2022 MyTruAdvantage Select (HMO)

The MyTruAdvantage Select (HMO) plan offers a $0 premium, deductible and PCP copay, prescription drug coverage, an enhanced dental benefit, and all the extras you can count on.

  • $0 monthly premium
  • $0 PCP copay
  • Robust Dental Benefit
  • $0 medical and prescription deductibles
  • Additional Savings for Select Insulins
  • Vision with hardware allowance
  • Hearing aid discounted pricing
  • Over-the-counter allowance
  • Virtual Care/Telehealth
  • Gym membership and at-home fitness kits

*Service area includes the following counties: Bartholomew, Brown, Clay, Hamilton, Hancock, Howard, Jackson, Jennings, Johnson, Madison, Marion, Parke, Posey, Sullivan, Vanderburgh, Vermillion, Vigo, and Warrick

In-network Benefits

Annual Deductible


The amount you’ll pay for most covered in-network medical services before you start paying only copayments or coinsurance and MyTruAdvantage pays the balance.

Out-of-Pocket Maximum


This is the most you pay during a calendar year for in-network and out-of-network services before MyTruAdvantage begins to pay 100% of the allowed amount. This limit includes copayments and coinsurance payments. It does not include your monthly premium or Part D drug costs.

Inpatient Hospital Care


Per day, days 1 - 6Per day, days 7 and beyond

Outpatient Hospital Care


for each visit

Includes Ambulatory Surgical Center, Outpatient hospital and Observation Visits.

Doctor Visits


Each primary care physician (PCP) visitEach specialist visit

Preventive Care


Each service

Includes immunizations, physical exams (initial exam and annual wellness visit), colorectal screening, pap smears and pelvic exams screening, prostate cancer screening, bone mass measurement, mammography screening, and outpatient hospital services - preventive

Emergency & Urgent Care


Each emergency room visitEach urgent care visit

Lab Services (Outpatient Diagnostic)


Each service

Tests and Procedures (Outpatient Diagnostic)


Each service

Outpatient X-rays


Each service

Complex Radiology/Imaging


Each service

This includes what you pay for radiology/imaging services such as a CT scan or MRI

Radiation Therapy


Each service

Routine Hearing Exam


up to one per year

Routine hearing services must be provided by a TruHearing provider.

Hearing Aid

$699, $999

Depending on the type

Preventive (Routine) Dental


Each service

Cleanings & exams (2 per year), and bitewing x-rays (one per year). 50% of the cost for fillings, crown repairs, brush biopsy, relines, and repairs to bridges and dentures.

Routine Vision Exam


Each exam

Routine vision services must be provided by an "Eyemed Select" provider.



Annual benefit amount

Mental Health Care Inpatient Visit


Each day, Days 1-5/days 6-90

Outpatient Group and Individual Therapy


Each visit

Skilled Nursing Facility


Each day, Days 1-20/Days 21-100

This plan covers up to 100 days each benefit period

Physical Therapy


Each visit



Each trip, Ground/air


Not Covered

Over-the-Counter (OTC) Card


Every 3 months

The OTC benefit offers you an easy way to get generic over-the-counter health and wellness products by phone at 1-888-628-2770 (TTY: 711) or online at www.cvs.com/otchs/MyTruAdvantage. You order from a list of approved OTC items, and OTC Health Solutions will mail them directly to your home address.

Fitness Benefit


Includes a no-cost gym membership at a participating fitness center or YMCA, one Stay Fit Kit (options include a Fitbit, Garmin, yoga, or strength kit), and 2 home fitness kits, where you can choose from 34 options like Aqua, Tai Chi, Chair-based exercise and more.

Prescription Drug Benefits - Part B

Medicare Part B Drugs may require prior authorization. The copay for chemotherapy drugs and other Part B drugs is 20%. Step Therapy may be required for certain Part B drugs (see Chapter 4 section 2.1 "Medicare Part B Drugs" of the EOC at www.MyTruAdvantage.com/Members for more details).

Prescription Drug Benefits - Part D

The below tables are broken out by preferred pharmacy, standard pharmacy and mail order. Please see the Pharmacy list to see what pharmacies are in which category.

Download the Pharmacy List

Annual Deductible


For all tiers

Tier 1 (Preferred Generic), Tier 2 (Generic), Tier 3 (Preferred Brand), Tier 4 (Non-Preferred Drug), Tier 5 (Specialty Tier)

Initial Coverage



You pay the following until your total yearly drug costs reach $4430. Total yearly drug costs are the total drug costs paid by both you and our Part D plan. Once you reach that amount, you will enter the Coverage Gap. You may get your drugs at network retail pharmacies and mail order pharmacies. During this stage, your out-of-pocket costs for Select Insulins will be $35 for a one-month (30-day) supply.

Tier 1 (Preferred generic)


Preferred retail (30-day)Standard retail (30-day)Mail order (90-day)

Tier 2 (Generic)


Preferred retail (30-day)Standard retail (30-day)Mail order (90-day)

Tier 3 (Preferred Brand)


Preferred retail (30-day)Standard retail (30-day)Mail order (90-day)

Tier 4 (Non-preferred Drug)


Preferred retail (30-day)Standard retail (30-day)Mail order (90-day)

Tier 5 (Specialty)

33% of cost

Preferred and standard retail (30-day)

Coverage Gap



When you reach your total yearly drug cost (which includes what our plan has paid and what you have paid) of $4430, you'll enter what is called a coverage gap. At this time, you wil pay 25% of the plan's cost for covered generic drugs and 25% of the plan's cost for covered brand drugs, plus dispensing fee, until your total costs reach $7050.

Most Medicare plans have this coverage gap (also called the "donut hole"), but not everyone will enter the coverage gap. During this stage, your out-of-pocket costs for Select Insulins will be $35 for a one-month (30-day) supply

Catastrophic Coverage



After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7050, you pay the greater of: 5% of the cost, or $3.95 copay for generic (including brand drugs treated as generic) and a $9.85 copay for all other drugs


*Certain procedures, services and drugs may need advance approval from your plan. This is called a "prior authorization" or "preauthorization". Please refer to the plan's Evidence of Coverage for all services that require Prior Authorization.