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MVP Medicare Preferred Gold without Part D (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MVP Medicare Preferred Gold without Part D (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MVP Medicare Preferred Gold without Part D (HMO-POS) in 2025, please refer to our full plan details page.
MVP Medicare Preferred Gold without Part D (HMO-POS) is a HMO-POS plan offered by MVP Health Care, Inc. available for enrollment in 2025 to people living in Western NY (Rochester/Buffalo). This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that MVP Medicare Preferred Gold without Part D (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about MVP Medicare Preferred Gold without Part D (HMO-POS).
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 MVP Medicare Preferred Gold without Part D (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7200.00 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 MVP Medicare Preferred Gold without Part D (HMO-POS)
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Drug Coverage
Prescription drugs are not covered by MVP Medicare Preferred Gold without Part D (HMO-POS).
Additional Benefits
The MVP Medicare Preferred Gold without Part D (HMO-POS) plan offers a range of benefits, including inpatient and outpatient services with varying copays. This plan covers primary care, preventive services, hearing, vision, and dental services, with specific copays and coinsurance amounts depending on the service. Ambulance, emergency, and transportation services are covered with copays. Additional benefits include home health services with no copay, and coverage for medical equipment. The plan also provides coverage for home infusion, dialysis, and skilled nursing facility stays. Other services like acupuncture and over-the-counter items are covered, with specific limits and cost-sharing arrangements.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $375 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $325 copay, ambulatory surgical center services have a $200 copay, and outpatient substance abuse services have a $30 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, but requires prior authorization. The copay for this benefit is $30.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $150 copay for ground ambulance services and a $250 copay for air ambulance services. Transportation Services to a plan-approved health-related location are covered for 12 one-way trips per year, but transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the MVP Medicare Preferred Gold without Part D (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Worldwide Urgent Coverage has a $110 copay, Worldwide Emergency Transportation has a $150 copay, and Urgently Needed Services has a $45 copay; all services have no coinsurance.
Primary Care See details
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 are covered. Chiropractic Services have a $15 copay, Occupational Therapy Services have a $20 copay, Physician Specialist Services have a $30 copay, and Physical Therapy and Speech-Language Pathology Services have a $20 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $30 copay for individual and group sessions. Podiatry Services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services, are covered. Health Education, Post discharge In-Home Medication Reconciliation, Fitness Benefit (Memory Fitness), Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered. However, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, 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.
Hearing Services See details
Hearing services are covered, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $699 and $999, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $30 copay, and eyewear with 20% coinsurance for contact lenses, and a combined maximum of $175 per year for all eyewear. Routine eye exams are covered once per year.
Dental Services See details
Dental Services include coverage for Medicare dental services with a $30 copay, while other dental services have a maximum plan benefit of $1,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery are covered. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the MVP Medicare Preferred Gold without Part D (HMO-POS) plan, but require prior authorization. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered by MVP Medicare Preferred Gold without Part D (HMO-POS), including Durable Medical Equipment with a 20% coinsurance and Prosthetic Devices with a 0-20% coinsurance. Diabetic Equipment is covered, but Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 10% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a $10 copay, while Lab Services are not covered. Diagnostic Radiological Services have a copay between $30 and $150, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by the MVP Medicare Preferred Gold without Part D (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the MVP Medicare Preferred Gold without Part D (HMO-POS) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by MVP Medicare Preferred Gold without Part D (HMO-POS) with prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under Other Services, acupuncture is covered with 50% coinsurance up to 10 treatments per year. Over-the-counter items are covered up to $25 every three months. The meal benefit is covered for a chronic illness, and requires prior authorization. Some services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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