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MVP Medicare Preferred Gold with 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 with 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 with Part D (HMO-POS) in 2025, please refer to our full plan details page.
MVP Medicare Preferred Gold with 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 with Part D (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about MVP Medicare Preferred Gold with 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 with Part D (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $219.00. 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.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6800.00 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 with Part D (HMO-POS)
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Drug Coverage
The MVP Medicare Preferred Gold with Part D (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, for a standard pharmacy, you will pay a $10 copay for preferred generic drugs, and 25% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your monthly Part D premium is $53.10.
Additional Benefits
The MVP Medicare Preferred Gold with Part D (HMO-POS) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services with varying copays, and partial hospitalization. The plan also covers ambulance services, emergency services, and a wide array of primary care services with copays for specialist visits. Additional benefits include preventive services with no copay, hearing and vision services, and extensive dental coverage. The plan provides coverage for home infusion, dialysis, medical equipment, and diagnostic services, with some services requiring coinsurance or prior authorization. The plan also covers home health services and skilled nursing facility stays with copays.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $375 for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a $350 copay, observation services with a $350 copay, ambulatory surgical center (ASC) services with a $250 copay, outpatient substance abuse services with a $10 copay for both individual and group sessions, and outpatient blood services. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the MVP Medicare Preferred Gold with Part D (HMO-POS) plan, but requires prior authorization. You will have a $40 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MVP Medicare Preferred Gold with Part D (HMO-POS) plan. Ground ambulance services have a $200 copay, while air ambulance services have a $400 copay, and there is no coinsurance for either. Transportation services to plan-approved health-related locations are covered for up to 24 one-way trips per year, using rideshare services, bus/subway, medical transport, or other modes of transportation. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the MVP Medicare Preferred Gold with Part D (HMO-POS) plan. Emergency Services has a $110 copay, Urgently Needed Services has a $35 copay, and Worldwide Emergency Services has a copay of $110 for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $200 copay for Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician 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 are covered with a $15 copay, but Routine Chiropractic Care is not covered. For Occupational Therapy, you will pay a $20 copay. For Physician Specialist Services, there is a $40 copay. Individual and Group Sessions for Mental Health and Psychiatric Services have a copay between $10 and $10. Physical Therapy and Speech-Language Pathology Services have a $20 copay. Opioid Treatment Program Services have a copay between $10 and $10.
Preventive Services See details
Preventive services are covered, including Medicare-covered services with no copay, an annual physical exam, additional preventive services requiring prior authorization, health education, post-discharge in-home medication reconciliation, fitness benefits (memory fitness), remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. In-home safety assessment, personal emergency response systems, 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 benefits, 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 include routine hearing exams and fitting/evaluation for hearing aids, with no deductible. Routine hearing exams are limited to one per year, and fitting/evaluation for hearing aids has no limit. Prescription hearing aids (all types) are covered with a copay between $699 and $999, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a $40 copay and eyewear with 20% coinsurance for contact lenses. This plan also covers routine eye exams, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The MVP Medicare Preferred Gold with Part D (HMO-POS) plan covers Medicare Dental Services with a $40 copay, and also covers other dental services including 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. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the MVP Medicare Preferred Gold with Part D (HMO-POS) plan, with Durable Medical Equipment (DME) subject to a 20% coinsurance and Prosthetic Devices covered with a 0-20% coinsurance. Diabetic Therapeutic Shoes/Inserts are covered with a 10% coinsurance. Durable Medical Equipment for use outside the home, Medical Supplies, and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with all diagnostic procedures and tests subject to a copay between $15 and $15. Lab services are not covered. Diagnostic Radiological Services have a copay between $40 and $200, while Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the MVP Medicare Preferred Gold with Part D (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MVP Medicare Preferred Gold with Part D (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter items, and a meal benefit. Acupuncture has a 50% coinsurance, and is limited to 10 treatments per year. Over-the-counter items are covered up to $100 every three months. The meal benefit requires prior authorization. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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