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Hamaspik Medicare Choice (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Hamaspik Medicare Choice (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Hamaspik Medicare Choice (HMO D-SNP) in 2025, please refer to our full plan details page.
Hamaspik Medicare Choice (HMO D-SNP) is a HMO D-SNP plan offered by Hamaspik of Rockland County, Inc. available for enrollment in 2025 to people living in NYC Metro Area and Hudson Valley Counties. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Hamaspik Medicare Choice (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Hamaspik Medicare Choice (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Hamaspik Medicare Choice (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Hamaspik Medicare Choice (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $69.50. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $13.40. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Hamaspik Medicare Choice (HMO D-SNP) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay the costs for your drugs in each tier. After your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase. If you qualify for the low-income subsidy (LIS), your Part D premium will be $69.50. Please refer to the plan's formulary for specific drug costs, as the provided information does not specify the cost for each tier.
Additional Benefits
The Hamaspik Medicare Choice (HMO D-SNP) plan offers a variety of services with cost-sharing through coinsurance, including outpatient, emergency, and primary care services, and also covers home infusion and dialysis services. Many services have a 20% coinsurance, but some services, like ambulance, home health, and diagnostic/radiological services, have no copay. This plan also provides additional benefits such as hearing and vision coverage, dental services, and medical equipment. The plan covers acupuncture with a limit of 20 treatments per year, and also provides an Over-the-Counter (OTC) allowance.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but additional days for either service, non-Medicare covered stays, and upgrades are not covered. For both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay the Medicare-defined cost share.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services, observation services, individual sessions for outpatient substance abuse, group sessions for outpatient substance abuse, and outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Hamaspik Medicare Choice (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Hamaspik Medicare Choice (HMO D-SNP) plan. Ground and Air Ambulance Services are covered with a 20% coinsurance, and there is no copay. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered with a 20% coinsurance. Worldwide Emergency Services are covered, with a maximum benefit of $50,000.
Primary Care See details
The Hamaspik Medicare Choice (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits and Opioid Treatment Program Services, all with a 20% coinsurance. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered by the Hamaspik Medicare Choice (HMO D-SNP) plan, but Annual Physical Exams, Health Education, In-Home Safety Assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visits have a 20% coinsurance.
Hearing Services See details
Hearing services are partially covered by the Hamaspik Medicare Choice (HMO D-SNP) plan, with hearing exams having a coinsurance of at most 20%, but routine hearing exams, fitting/evaluations for hearing aids, prescription hearing aids of all types, and OTC hearing aids are not covered. There is no deductible for hearing exams.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are covered once every two years. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, also have a 20% coinsurance and a combined maximum plan benefit coverage amount of $200 every two years.
Dental Services See details
The Hamaspik Medicare Choice (HMO D-SNP) plan covers dental services with 20% coinsurance for Medicare Dental Services. Oral exams and dental x-rays are limited to 2 per year, and prophylaxis (cleaning) is limited to 2 per year. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Hamaspik Medicare Choice (HMO D-SNP) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with no copay, and Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Equipment also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services each have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Hamaspik Medicare Choice (HMO D-SNP) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Hamaspik Medicare Choice (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays, or non-Medicare-covered SNF stays. Prior authorization is required and the cost sharing is the same as Original Medicare.
Other Services See details
The Hamaspik Medicare Choice (HMO D-SNP) plan covers acupuncture with a limit of 20 treatments per year, and also covers Over-the-Counter (OTC) items up to $215.00 every month. However, the plan does not cover meal benefits, Dual Eligible SNPs with Highly Integrated Services, or any of the listed additional services.
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