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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 2026, 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 out of 5 stars in 2026.
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 robust medical coverage with no copays or coinsurance for primary care and telehealth visits. Specialist visits require a $30 copay, while inpatient hospital stays cost a $375 daily copay for the first five days and no copay for days six through 90. Outpatient hospital services feature a $325 copay per stay, and emergency room visits have a $115 copay which is waived if you are admitted within 24 hours. Preventive care, routine hearing exams, and home health services are covered with no copays or coinsurance. For supplemental care, the plan provides up to a $1,000 annual allowance for select dental services with no copay, a $30 copay for routine annual eye exams, and a quarterly $25 allowance for over-the-counter items. Skilled nursing facility stays are also covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
MVP Medicare Preferred Gold without Part D (HMO-POS) covers inpatient hospital services with no coinsurance and a copay of $375 per day for days 1 through 5, and no copay for days 6 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric hospital days are not covered, and prior authorization is required.
Outpatient Services See details
MVP Medicare Preferred Gold without Part D (HMO-POS) covers outpatient services with no coinsurance, requiring a $325 copay per stay for outpatient hospital and observation services, and a $200 copay for ambulatory surgical center services. Outpatient substance abuse sessions have a $30 copay with no coinsurance, while outpatient blood services are covered with no copay or coinsurance, with prior authorization required for these benefits.
Partial Hospitalization See details
MVP Medicare Preferred Gold without Part D (HMO-POS) covers partial hospitalization services with a $50 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
MVP Medicare Preferred Gold without Part D (HMO-POS) covers ground ambulance services with a $200 copay and air ambulance services with a $300 copay, both with no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
MVP Medicare Preferred Gold without Part D (HMO-POS) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $115 to $200.
Primary Care See details
MVP Medicare Preferred Gold without Part D (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance. Specialist visits, mental health, psychiatric, and opioid treatment services require a $30 copay and no coinsurance, whereas physical and occupational therapies require a $20 copay and no coinsurance, and podiatry and chiropractic services are not covered.
Preventive Services See details
MVP Medicare Preferred Gold without Part D (HMO-POS) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance (prior authorization required), but do not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety devices, or counseling services.
Hearing Services See details
MVP Medicare Preferred Gold without Part D (HMO-POS) covers routine hearing exams and fittings with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $699 to $999 for up to two devices per year, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
MVP Medicare Preferred Gold without Part D (HMO-POS) partially covers vision services, offering one routine eye exam per year with a $30 copay and no coinsurance up to a $70 maximum, though other eye exam services are not covered. Eyewear is covered with no copay and a 20% coinsurance for contact lenses, up to a combined annual maximum of $150 for contacts, lenses, frames, and upgrades.
Dental Services See details
MVP Medicare Preferred Gold without Part D (HMO-POS) offers partially covered dental services, featuring Medicare-covered dental for a $30 copay and no coinsurance, and other dental services with no copay and no coinsurance up to a $1,000 annual maximum. Orthodontics is not covered under this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by MVP Medicare Preferred Gold without Part D (HMO-POS) with no copay, though prior authorization is required. Medicare Part B chemotherapy and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and up to 20% coinsurance.
Dialysis Services See details
MVP Medicare Preferred Gold without Part D (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Medical Equipment is partially covered by MVP Medicare Preferred Gold without Part D (HMO-POS), offering no copays for covered items, though prior authorization is required. Durable medical equipment requires a 20% coinsurance, prosthetic devices range from no coinsurance to 20% coinsurance, and diabetic therapeutic shoes or inserts have a 10% coinsurance, while medical supplies and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
MVP Medicare Preferred Gold without Part D (HMO-POS) partially covers diagnostic and radiological services, requiring prior authorization and excluding lab services. Diagnostic procedures require a $10 copay with no coinsurance, diagnostic radiological services require a $30 copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by MVP Medicare Preferred Gold without Part D (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are partially covered under MVP Medicare Preferred Gold without Part D (HMO-POS) with no coinsurance, although prior authorization is required. Covered additional cardiac rehabilitation services require a $20 copay, while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
MVP Medicare Preferred Gold without Part D (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
MVP Medicare Preferred Gold without Part D (HMO-POS) covers acupuncture with no copay and 50% coinsurance for up to 10 treatments annually, and chronic illness meals with no copay and no coinsurance. Over-the-counter (OTC) items are also covered with no copay and no coinsurance up to $25 every three months, though nicotine replacement therapy and naloxone are not covered.
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