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Senior Whole Health NHC (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Whole Health NHC (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Senior Whole Health NHC (HMO D-SNP) in 2025, please refer to our full plan details page.
Senior Whole Health NHC (HMO D-SNP) is a HMO D-SNP plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Brstl, Essx, Hmpdn, Mdlsx, Nrflk, Plmth, Sflk, Wor. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Senior Whole Health NHC (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:
Senior Whole Health NHC (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 Senior Whole Health NHC (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 Senior Whole Health NHC (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.80. 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 $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:
Sign up for Senior Whole Health NHC (HMO D-SNP)
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Drug Coverage
The Senior Whole Health NHC (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you pay the cost sharing for each drug. The plan's formulary provides specific costs for drugs in each tier. If you qualify for the low-income subsidy, your monthly premium for Part D drugs is $23.80. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Senior Whole Health NHC (HMO D-SNP) plan offers coverage for a wide range of services. This includes inpatient and outpatient hospital care, emergency services, primary care, and home health services. Many services, such as ambulance, vision, and dental, have a 20% coinsurance, while some services, like transportation and medical equipment, have no copay. Additionally, the plan provides benefits for hearing, and offers coverage for home infusion, dialysis, medical equipment, and diagnostic services. Other notable benefits include acupuncture, and an over-the-counter (OTC) allowance of up to $75 per month. The plan does not cover some services, such as hearing aids, podiatry, orthodontic, and additional days in a skilled nursing facility.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but additional days, non-Medicare-covered stays, and upgrades for both are not covered. The plan's cost sharing aligns with the Medicare-defined cost share.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, and outpatient substance abuse services. Outpatient hospital services and observation services have a 20% coinsurance, and outpatient substance abuse services have a 20% coinsurance for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, but requires prior authorization. You will pay a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a 20% coinsurance, and Transportation Services to a plan-approved health-related location are covered for up to 80 one-way trips per year, with no copay, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered, each with a 20% coinsurance and no copay. Worldwide Emergency Services has a maximum plan benefit coverage of $10,000.
Primary Care See details
The Senior Whole Health NHC (HMO D-SNP) plan covers Primary Care services, including Primary Care Physician Services, with a 20% coinsurance. Chiropractic Services are partially covered, with Routine Care not covered, and a 20% coinsurance for covered services. Occupational Therapy Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services are covered with a 20% coinsurance. Mental Health Specialty Services and Psychiatric Services are covered and have a 20% minimum and maximum coinsurance for Individual and Group sessions. Other Health Care Professional Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are also covered. Podiatry Services are not covered.
Preventive Services See details
Preventive services are covered, but annual physical exams, 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 benefits, home-based palliative care, in-home support services, and support for caregivers of enrollees are not covered. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have a 20% coinsurance. Health education, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, and home and bathroom safety devices are also covered.
Hearing Services See details
Hearing services are partially covered by Senior Whole Health NHC (HMO D-SNP), but routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered. Hearing exams have a coinsurance of at most 20%, with no deductible.
Vision Services See details
Vision Services includes coverage for eye exams with a 20% coinsurance, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames and upgrades, all with a 20% coinsurance. The plan offers a combined maximum of $200 per year for eyewear.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Senior Whole Health NHC (HMO D-SNP) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs, with a coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the Senior Whole Health NHC (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment are covered under the Senior Whole Health NHC (HMO D-SNP) plan. For DME, there is a 20% coinsurance and no copay, but Durable Medical Equipment for use outside the home is not covered. For Prosthetics, Medical Supplies, and Diabetic Supplies and Services, there is a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Senior Whole Health NHC (HMO D-SNP) plan. All diagnostic services and radiological services are covered with no copay, but may have up to 20% coinsurance for some services like Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services.
Home Health Services See details
Home Health Services are covered by the Senior Whole Health NHC (HMO D-SNP) plan with no copay and no coinsurance, although authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required and the plan charges the Medicare-defined cost share for tier 1.
Other Services See details
The Senior Whole Health NHC (HMO D-SNP) plan covers acupuncture, up to 40 treatments per year, and over-the-counter (OTC) items, with a maximum benefit of $75.00 every month, including nicotine replacement therapy and Naloxone coverage. Meal benefit, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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