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Trinity Health Plan of Michigan Glory No RX (HMO) Medicare Advantage Plan H9179-003 • 2027

CMS Rating: ☆☆☆☆☆ (3.0 out of 5 stars*)
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$6500.00In-network
Part B Giveback
−$100.00 reduction
Prescription Coverage
Not Included
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
139 beneficiaries
Last update:

Trinity Health Plan of Michigan Glory No RX (HMO) Introduction

Trinity Health Plan of Michigan Glory No RX is a Medicare Advantage HMO plan offered by Trinity Health Plan of Michigan. It uses a Health Maintenance Organization (HMO) provider network and comes without prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $0.00 medical deductible, and $6500.00 in-network maximum out-of-pocket. CMS Plan ID H9179-003 identifies this plan.

Plan Benefits

Trinity Health Plan of Michigan Glory No RX has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H9179-003.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay In-network: $0 copay
Specialist In-network: $30 copay In-network: $30 copay

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam In-network: $0 copay In-network: $0 copay
Telehealth benefit In-network: $0-$30 copay In-network: $0-$30 copay
Routine chiropractic Not covered Not covered
Fitness benefits Coming soon In-network: $0 copay
Health education Not covered Not covered
Counseling services Not covered Not covered
Over-the-counter drug benefits In-network: $0 copay In-network: $0 copay
Health transportation (non-emergency) Coming soon Not covered

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $300 copay In-network: $300 copay
Lab services In-network: $0 copay In-network: $0 copay
Outpatient x-rays In-network: $30 copay In-network: $30 copay
Diagnostic tests and procedures In-network: $50 copay In-network: $30 copay

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $130 copay $130 copay
Worldwide emergency care Coming soon $130 copay
Urgent care $45 copay $45 copay
Inpatient hospital care Tier 1
$325 per day for days 1-7
$0 per day for days 8-90
$0 per stay		 Tier 1
$295 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Skilled Nursing Facility Tier 1
$0 per day for days 1-20
$221 per day for days 21-65
$0 per day for days 66-100		 Tier 1
$0 per day for days 1-20
$218 per day for days 21-60
$0 per day for days 61-100
Ground ambulance In-network: $275 copay In-network: $275 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $30 copay In-network: $30 copay
Outpatient group therapy In-network: $30 copay In-network: $30 copay
Inpatient psychiatric hospital care Tier 1
$325 per day for days 1-7
$0 per day for days 8-90
$0 per stay		 Tier 1
$295 per day for days 1-7
$0 per day for days 8-90
$0 per stay

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $20 copay In-network: $20 copay
Occupational therapy In-network: $20 copay In-network: $20 copay

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: $0 copay In-network: $0 copay
Durable medical equipment In-network: 20% coinsurance In-network: 20% coinsurance
Prosthetics In-network: 20% coinsurance In-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered) In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay In-network: $0 copay
Dental x-rays In-network: $0 copay In-network: $0 copay
Cleaning In-network: $0 copay In-network: $0 copay
Periodontics In-network: 70% coinsurance In-network: 70% coinsurance
Endodontics In-network: 70% coinsurance In-network: 70% coinsurance
Restorative services In-network: 50% coinsurance In-network: 50% coinsurance
Implant services Not covered Not covered
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery In-network: 50% coinsurance In-network: 50% coinsurance

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $0 copay In-network: $0 copay
Contact lenses In-network: $0 copay In-network: $0 copay
Eyeglass frames only In-network: $0 copay In-network: $0 copay
Eyeglass lenses only In-network: $0 copay In-network: $0 copay
Eyeglasses (frames & lenses) In-network: $0 copay In-network: $0 copay
Upgrades Not covered Not covered

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay In-network: $0 copay
Fitting/evaluation In-network: $0 copay In-network: $0 copay
Prescription hearing aids In-network: $599-$899 copay In-network: $599-$899 copay
OTC hearing aids Not covered Not covered

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Not covered
Home-based palliative care Not covered Not covered
Personal emergency response system Coming soon Not covered
Weight management programs Not covered Not covered
Wigs for chemotherapy-related hair loss Coming soon Not covered
Alternative therapies Not covered Not covered
Massage therapy Not covered Not covered
Home/bathroom safety devices Not covered Not covered

Certain preventive services are covered 100% by Trinity Health Plan of Michigan Glory No RX as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

CMS 5-Star Performance Ratings (Contract ID: H9179)

Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.

2027 Medicare Star Ratings for Contract H9179
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines Plan too new to be measured
Managing Chronic (Long Term) Conditions Plan too new to be measured
Member Experience with Health Plan ☆☆☆☆☆
Complaints and Changes in Plans Performance ☆☆☆☆☆
Health Plan Customer Service Plan too new to be measured
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan ☆☆☆☆☆
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆

Contact Information for Trinity Health Plan of Michigan

Website
Trinity Health Plan of Michigan Plan Page
Providers
Trinity Health Plan of Michigan Providers Page
Formulary
Trinity Health Plan of Michigan Formulary Page
Pharmacy
Trinity Health Plan of Michigan Pharmacy Page
New Member Health Plan Help
(800)964-4525
New Member Health Plan TTY
711

Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.

Frequently Asked Questions

Here are some of the most frequently asked questions about this plan (click to open).

Frequently Asked Questions About Trinity Health Plan of Michigan Glory No RX (HMO)

How much does plan H9179-003 cost per month?

The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.

What is the annual out-of-pocket maximum (MOOP) for this plan?

The annual in-network MOOP is $6500.00 for 2027. After this limit is reached, covered in-network services are fully paid.

How many beneficiaries are enrolled in this plan?

CMS reports 139 beneficiaries enrolled in this plan.

What is the prescription drug deductible for 2027?

For 2027, the prescription drug deductible is $0.00.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Trinity Health Plan of Michigan (official source) http://www.thpmedicare.org/michigan October 4, 2026
Medicare.gov Understanding Medicare Advantage Plans 25 May, 2025
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You 25 May, 2025
Medicare.gov Explore your Medicare coverage options 25 May, 2025

MedicarePlans.com operates as an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.

Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.