2023 Medicare Advantage Plan Details | ||||||||
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Medicare Plan Name: | MVP DualAccess (HMO D-SNP) | |||||||
Location: | Greene, New York Click to see other locations | |||||||
Plan ID: | H3305 - 033 - 0 Click to see other plans | |||||||
Member Services: | 1-866-954-1872 TTY users 1-800-662-1220 | |||||||
— This plan information is for research purposes only. — Click here to see plans for the current plan year | ||||||||
Medicare Contact Information: | Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048 or contact your local SHIP for assistance |
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Email a copy of the MVP DualAccess (HMO D-SNP) benefit details | ||||||||
— Medicare Plan Features — | ||||||||
Monthly Premium: | $-1.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) | |||||||
Annual Rx Deductible: | $0 for people who qualify for both Medicare and Medicaid. | |||||||
Annual Rx Initial Coverage Limit (ICL): | $4,660 | |||||||
Health Plan Type: | Local HMO | |||||||
Special Needs Plan (SNP) Eligibility Requirement: | Dual-Eligible | |||||||
Additional Rx Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | |||||||
Total Number of Formulary Drugs: | 3,658 drugs | Browse the MVP DualAccess (HMO D-SNP) Formulary | ||||||
This plan has drug tiers. See cost-sharing for all pharmacies and tiers. | ||||||||
Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less. | ||||||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 | |||
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | cost-sharing data not available. | |||||||
• Number of Drugs per Tier: | ||||||||
Plan Offers Mail Order? | Yes | |||||||
Medicare Plan Pharmacy Numbers: | BIN: 004336 PCN: MEDDADV See BIN/PCNs for all plans | |||||||
Number of Members enrolled in this plan in Greene, New York: | less than 10 members | |||||||
Number of Members enrolled in this plan in (H3305 - 033): | 997 members | |||||||
Plan’s Summary Star Rating: | 5 out of 5 Stars. This plan qualifies for the 5-star rating Special Enrollment period. Read more. | |||||||
• Customer Service Rating: | 4 out of 5 Stars. | |||||||
• Member Experience Rating: | 5 out of 5 Stars. | |||||||
• Drug Cost Accuracy Rating: | 4 out of 5 Stars. | |||||||
— Plan Premium Details — | ||||||||
Monthly Premium with Extra Help Low-Income Subsidy (LIS): | data not available |
— Plan Health Benefits — | |||||
** Base Plan ** | |||||
Premium | |||||
• Health plan premium: $0 | |||||
• Drug plan premium: $0 | |||||
• You must continue to pay your Part B premium. | |||||
• Part B premium reduction: No | |||||
Deductible | |||||
• Health plan deductible: $0 | |||||
• Other health plan deductibles: In-network: No | |||||
• Drug plan deductible: $505.00 annual deductible | |||||
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | |||||
• $8,300 In-network | |||||
Optional supplemental benefits | |||||
• No | |||||
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions? | |||||
• In-network: No | |||||
Doctor visits | |||||
• Primary: $0 copay | |||||
• Specialist: $0 copay (authorization required) | |||||
Diagnostic procedures/lab services/imaging | |||||
• Diagnostic tests and procedures: $0 copay (authorization required) | |||||
• Lab services: $0 copay (authorization required) | |||||
• Diagnostic radiology services (e.g., MRI): $0 copay (authorization required) | |||||
• Outpatient x-rays: $0 copay (authorization required) | |||||
Emergency care/Urgent care | |||||
• Emergency: $0 copay | |||||
• Urgent care: $0 copay | |||||
Inpatient hospital coverage | |||||
• $0 copay (authorization required) | |||||
Outpatient hospital coverage | |||||
• $0 copay (authorization required) | |||||
Skilled Nursing Facility | |||||
• $0 copay (authorization required) | |||||
Preventive care | |||||
• $0 copay (authorization required) | |||||
Ground ambulance | |||||
• $0 copay | |||||
Rehabilitation services | |||||
• Occupational therapy visit: $0 copay (authorization required) | |||||
• Physical therapy and speech and language therapy visit: $0 copay (authorization required) | |||||
Mental health services | |||||
• Inpatient hospital - psychiatric: $0 copay (authorization required) | |||||
• Outpatient group therapy visit with a psychiatrist: $0 copay (authorization required) | |||||
• Outpatient individual therapy visit with a psychiatrist: $0 copay (authorization required) | |||||
• Outpatient group therapy visit: $0 copay (authorization required) | |||||
• Outpatient individual therapy visit: $0 copay (authorization required) | |||||
Medical equipment/supplies | |||||
• Durable medical equipment (e.g., wheelchairs, oxygen): $0 copay (authorization required) | |||||
• Prosthetics (e.g., braces, artificial limbs): $0 copay (authorization required) | |||||
• Diabetes supplies: $0 copay (authorization required) | |||||
Hearing | |||||
• Hearing exam: $0 copay (authorization required) | |||||
• Fitting/evaluation: Not covered | |||||
• Hearing aids - inner ear: Not covered | |||||
• Hearing aids - outer ear: Not covered | |||||
• Hearing aids - over the ear: Not covered | |||||
Preventive dental | |||||
• Oral exam: $0 copay (limits apply) | |||||
• Cleaning: $0 copay (limits apply) | |||||
• Fluoride treatment: Not covered | |||||
• Dental x-ray(s): $0 copay (limits apply) | |||||
Comprehensive dental | |||||
• Non-routine services: $0 copay (limits apply, authorization required) | |||||
• Diagnostic services: $0 copay (limits apply, authorization required) | |||||
• Restorative services: $0 copay (limits apply, authorization required) | |||||
• Endodontics: $0 copay (limits apply, authorization required) | |||||
• Periodontics: $0 copay (limits apply, authorization required) | |||||
• Extractions: $0 copay (limits apply, authorization required) | |||||
• Prosthodontics, other oral/maxillofacial surgery, other services: $0 copay (limits apply, authorization required) | |||||
Vision | |||||
• Routine eye exam: Not covered | |||||
• Other: Not covered | |||||
• Contact lenses: $0 copay (limits apply) | |||||
• Eyeglasses (frames and lenses): $0 copay (limits apply) | |||||
• Eyeglass frames: $0 copay (limits apply) | |||||
• Eyeglass lenses: $0 copay (limits apply) | |||||
• Upgrades: Not covered | |||||
Medically-approved non-opioid pain management services | |||||
• Chiropractic services: Not covered | |||||
• Acupuncture: Not covered | |||||
• Therapeutic Massage: Not covered | |||||
• Alternative Therapies: Not covered | |||||
More benefits | |||||
• Transportation services: Some coverage | |||||
• Over-the-counter drug benefits: Some coverage | |||||
• Meals for short duration: Some coverage | |||||
• Annual physical exams: Some coverage | |||||
• Telehealth: Some coverage | |||||
• WorldWide emergency: Not covered | |||||
• Fitness Benefit: Some coverage | |||||
• In-Home Support Services: Not covered | |||||
• Bathroom Safety Devices: Not covered | |||||
• Health Education: Some coverage | |||||
• In-Home Safety Assessment: Not covered | |||||
• Personal Emergency Response System (PERS): Not covered | |||||
• Medical Nutrition Therapy (MNT): Not covered | |||||
• Post discharge In-Home Medication Reconciliation: Not covered | |||||
• Re-admission Prevention: Not covered | |||||
• Wigs for Hair Loss Related to Chemotherapy: Not covered | |||||
• Weight Management Programs: Not covered | |||||
• Adult Day Health Services: Not covered | |||||
• Nutritional/Dietary Benefit: Not covered | |||||
• Home-Based Palliative Care: Not covered | |||||
• Support for Caregivers of Enrollees: Not covered | |||||
• Additional Sessions of Smoking and Tobacco Cessation Counseling: Not covered | |||||
• Enhanced Disease Management: Not covered | |||||
• Telemonitoring Services: Not covered | |||||
• Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline): Some coverage | |||||
• Counseling Services: Not covered | |||||
Wellness programs (e.g., fitness, nursing hotline) | |||||
• Covered (authorization required) | |||||
Transportation | |||||
• $0 copay (limits apply, authorization required) | |||||
Foot care (podiatry services) | |||||
• Foot exams and treatment: $0 copay (authorization required) | |||||
• Routine foot care: Not covered | |||||
Medicare Part B drugs | |||||
• Chemotherapy: $0 copay (authorization required) | |||||
• Other Part B drugs: $0 copay (authorization required) |