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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 2026, 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 3 out of 5 stars in 2026.
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 $51.50. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $615.00 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 $9250.00 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) prescription drug plan has an annual drug deductible of $615. Under this plan, you will need to pay this deductible amount for your medications before coverage begins. Because this is a Dual Eligible Special Needs Plan, your actual out-of-pocket costs for prescription drugs may be lower depending on your level of Medicaid eligibility or extra help. Specific drug tier details, including copays and coinsurance rates for generic and brand-name medications, are currently unavailable for this plan. To determine how your specific medications are covered, you should consult the plan's formulary or contact the plan provider directly.
Additional Benefits
The Hamaspik Medicare Choice (HMO D-SNP) plan offers comprehensive medical coverage with no copay for major services, though a 20% coinsurance applies to several outpatient and specialist benefits. You will pay no copay and no coinsurance for inpatient hospital stays, skilled nursing facility care, and home health services. However, a 20% coinsurance with no copay applies to outpatient hospital visits, emergency care, primary and specialist visits, and durable medical equipment. For supplemental healthcare, this plan features preventive and comprehensive dental services with no copay and no coinsurance, alongside diagnostic hearing exams. Vision benefits include coverage for routine exams and up to $200 for eyewear every two years, though a 20% coinsurance applies to routine exams and contact lenses. Members also receive extra perks like acupuncture and up to $250 per month in over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Hamaspik Medicare Choice (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization is required. These benefits are partially covered because upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Hamaspik Medicare Choice (HMO D-SNP) covers outpatient services with no copay, but a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for ambulatory surgical center, outpatient hospital, and observation services, and the deductible is waived for the first three pints of blood.
Partial Hospitalization See details
Partial hospitalization is covered by Hamaspik Medicare Choice (HMO D-SNP) with no copay and a 20% coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
Hamaspik Medicare Choice (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Hamaspik Medicare Choice (HMO D-SNP) with a 20% coinsurance and no copay for emergency and urgently needed care, which is waived if you are admitted to the hospital within 48 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum limit with no copay and no coinsurance.
Primary Care See details
Hamaspik Medicare Choice (HMO D-SNP) covers primary care, specialist, therapy, mental health, and telehealth services with no copay and a 20% coinsurance. Podiatry and chiropractic services are not covered under this plan.
Preventive Services See details
Hamaspik Medicare Choice (HMO D-SNP) partially covers preventive services, offering Medicare-covered zero-dollar services, fitness benefits, and remote access technologies with no copay and no coinsurance, while kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, and EKGs have no copay and a 20% coinsurance. Annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home modifications, and counseling are not covered.
Hearing Services See details
Hearing services under Hamaspik Medicare Choice (HMO D-SNP) cover diagnostic hearing exams with no copay, no deductible, and no coinsurance. Routine hearing exams, fitting and evaluations, and both prescription and over-the-counter hearing aids are not covered under this plan.
Vision Services See details
Vision services are partially covered by Hamaspik Medicare Choice (HMO D-SNP), as other eye exam services are not covered. Routine eye exams (one every two years) and eyewear (up to $200 every two years) are covered with no copays and no deductibles, though a 20% coinsurance applies to routine exams and contact lenses.
Dental Services See details
Hamaspik Medicare Choice (HMO D-SNP) partially covers dental services, offering most preventive and comprehensive care with no copay and no coinsurance, while Medicare-covered dental services require no copay and a 20% coinsurance. Prior authorization is required for many services, and maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Hamaspik Medicare Choice (HMO D-SNP) covers home infusion bundled services with no copay, though associated Medicare Part B chemotherapy and other drugs require a coinsurance ranging from no coinsurance up to 20%. Medicare Part B insulin drugs are also covered under this benefit with a $35 copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered by Hamaspik Medicare Choice (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Hamaspik Medicare Choice (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these services, and there are no preferred manufacturer or vendor restrictions.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Hamaspik Medicare Choice (HMO D-SNP), requiring prior authorization with a 20% coinsurance and no copay for covered services. While diagnostic procedures, therapeutic radiological services, and outpatient X-rays are covered, lab services are not covered under this plan.
Home Health Services See details
Hamaspik Medicare Choice (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services under Hamaspik Medicare Choice (HMO D-SNP) are covered with no copay, but prior authorization is required. While some services are covered, specific options like cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Hamaspik Medicare Choice (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. Admission is allowed with less than a three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Hamaspik Medicare Choice (HMO D-SNP) offers partial coverage for other services, which includes acupuncture and over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture is limited to 20 treatments per year, and OTC items are covered up to $250 per month, while meal benefits and nicotine replacement therapy are not covered.
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