A non-government entity
Senior Whole Health SCO NHC (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Whole Health SCO 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 SCO NHC (HMO D-SNP) in 2026, please refer to our full plan details page.
Senior Whole Health SCO 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, Hdn, Ham, Mdsx, Nrflk, Plth, Sfk, Wor. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Senior Whole Health SCO 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 SCO 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 SCO 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 SCO NHC (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.50. 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:
Sign up for Senior Whole Health SCO NHC (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Senior Whole Health SCO NHC (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for covered medications before the plan begins to pay its share. Specific drug coverage tier details, including individual copayments and coinsurance rates, are currently unavailable for this plan. To understand your exact medication costs under this plan, it is recommended to review the plan's specific formulary or contact the provider directly.
Additional Benefits
The Senior Whole Health SCO NHC (HMO D-SNP) plan offers comprehensive medical coverage with no copays for most primary services, though coinsurance rates apply in several areas. Members enjoy inpatient hospital stays, home health, and skilled nursing facility care with no copay and no coinsurance. For outpatient services, specialist visits, and emergency care, there are no copays, but you will pay a coinsurance ranging from 10% to 30%. Preventive care, fitness programs, and select dental services are also fully covered with no copay and no coinsurance. For other essential needs, the plan features no copays but requires a 20% coinsurance on durable medical equipment, dialysis, and Medicare-covered dental services. Vision benefits include eyewear with no copay or deductible, while hearing care covers diagnostic exams but excludes routine tests and hearing aids.
Inpatient Hospital See details
Senior Whole Health SCO NHC (HMO D-SNP) partially covers inpatient hospital services, including acute and psychiatric care, with no copay and no coinsurance, subject to prior authorization. However, additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Outpatient services are covered by Senior Whole Health SCO NHC (HMO D-SNP) with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Prior authorization is required for most of these services, and outpatient blood services also feature no copay and a 20% coinsurance with the deductible waived for the first three pints.
Partial Hospitalization See details
Senior Whole Health SCO NHC (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Senior Whole Health SCO NHC (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. While transportation services are technically listed as covered, they are not covered in practice as trips to plan-approved and general health-related locations are excluded.
Emergency Services See details
Senior Whole Health SCO NHC (HMO D-SNP) covers emergency and urgently needed services with a 30% coinsurance and no copay, which count toward the plan-level deductible and have maximum per-visit limits of $115 and $40 respectively. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance up to a maximum benefit limit of $10,000.
Primary Care See details
Senior Whole Health SCO NHC (HMO D-SNP) covers primary care and specialist visits with no copay and a 10% coinsurance, while mental health, psychiatry, and physical, occupational, and speech therapies require no copay and a 30% coinsurance. Opioid treatment has no copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Senior Whole Health SCO NHC (HMO D-SNP) partially covers preventive services, offering Medicare-covered zero-dollar preventive benefits, fitness programs, and health education with no copay and no coinsurance. Kidney disease education and select screenings, such as glaucoma and diabetes self-management, carry a 20% coinsurance with no copay, while annual physical exams, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Senior Whole Health SCO NHC (HMO D-SNP) hearing services include partially covered hearing exams with no copay, no coinsurance, and no deductible, though routine hearing exams and fitting or evaluation services are not covered. While prescription hearing aids are technically covered, only some services are covered in practice, and prescription hearing aids of all types—including inner ear, outer ear, and over the ear—as well as OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Senior Whole Health SCO NHC (HMO D-SNP), as eye exams are not covered, but eyewear is covered with no copay or deductible. Eyeglasses and upgrades have no coinsurance, while contact lenses require a 20% coinsurance, up to a combined maximum benefit of $200 every year.
Dental Services See details
Senior Whole Health SCO NHC (HMO D-SNP) partially covers dental services, featuring Medicare-covered dental services with no copay and a 20% coinsurance, and other covered preventive and comprehensive dental services with no copay and no coinsurance. However, other diagnostic dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Senior Whole Health SCO NHC (HMO D-SNP) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance of up to 20%, while Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Senior Whole Health SCO NHC (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Senior Whole Health SCO NHC (HMO D-SNP) covers durable medical equipment, prosthetics, and diabetic supplies with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and certain items may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Senior Whole Health SCO NHC (HMO D-SNP) covers diagnostic and radiological services, including lab work, X-rays, and therapeutic radiology, with no copay and a minimum coinsurance of 20%. Prior authorization is required for these covered services.
Home Health Services See details
Home Health Services are covered under the Senior Whole Health SCO NHC (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Senior Whole Health SCO NHC (HMO D-SNP) covers some services under Cardiac Rehabilitation Services with no copay, but Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Senior Whole Health SCO NHC (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Senior Whole Health SCO NHC (HMO D-SNP) partially covers other services, offering acupuncture for up to 40 treatments per year and over-the-counter items with no copay and no coinsurance. Meal benefits and other additional services are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved