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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 2026, 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 out of 5 stars in 2026.
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 $229.00. 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 a $300.00 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 $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 features an annual drug deductible of $300. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and standard mail order. Tier 2 generic medications cost a low $2 copay for a 1-month supply, while a 3-month supply is $6 at standard pharmacies and $4 through standard mail order. For Tier 3 preferred brand drugs, you will pay a 16% coinsurance for both 1-month and 3-month supplies. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance for a 1-month supply. This structured coverage helps keep everyday generic medications affordable while sharing costs for brand-name and specialty prescriptions.
Additional Benefits
The MVP Medicare Preferred Gold with Part D (HMO-POS) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. If you require hospital care, inpatient stays have a $375 daily copay for the first five days and no copay for days six through 90, while outpatient hospital services require a $350 copay. Emergency room visits carry a $115 copay, which is waived if you are admitted, and specialist visits require a $40 copay. This plan also features valuable everyday benefits, including routine dental and hearing exams with no copay, alongside a $1,500 annual allowance for preventive and restorative dental care. Members can access up to 24 free one-way transportation trips to approved health locations per year and receive a $50 quarterly allowance for over-the-counter items. Additionally, skilled nursing facility stays require 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 with Part D (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring prior authorization and a copay of $375 per day for days 1-5, with no copay for days 6-90. While acute care includes unlimited additional days at no copay, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
MVP Medicare Preferred Gold with Part D (HMO-POS) covers outpatient hospital and observation services with a $350 copay per stay and no coinsurance, and ambulatory surgical center services with a $250 copay and no coinsurance. Outpatient substance abuse services require a $10 copay per session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
MVP Medicare Preferred Gold with Part D (HMO-POS) covers partial hospitalization services with a $50 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
MVP Medicare Preferred Gold with Part D (HMO-POS) covers ground ambulance services with a $200 copay and air ambulance services with a $400 copay, with no coinsurance required for either service. Transportation services to plan-approved health-related locations are covered with no copay and no coinsurance for up to 24 one-way trips per year, while transportation to other health-related locations is not covered.
Emergency Services See details
Emergency services are covered by MVP Medicare Preferred Gold with Part D (HMO-POS) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $35 copay and no coinsurance, while worldwide emergency and urgent services require a $115 copay, and worldwide emergency transportation has a $200 copay, all with no coinsurance.
Primary Care See details
MVP Medicare Preferred Gold with Part D (HMO-POS) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Physical, occupational, and speech therapies have a $20 copay and no coinsurance, mental health services require a $10 copay and no coinsurance, and podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive Services are partially covered by MVP Medicare Preferred Gold with Part D (HMO-POS) with no copay and no coinsurance, though prior authorization is required for select benefits. Covered services include annual physicals and kidney disease education, while excluded services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
MVP Medicare Preferred Gold with Part D (HMO-POS) covers hearing exams with no copay and no coinsurance, including one routine exam per year and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay of $699 to $999 for up to two devices per year, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by MVP Medicare Preferred Gold with Part D (HMO-POS), as other eye exam services are not covered. Routine eye exams are covered with a $40 copay and no coinsurance, and eyewear is covered with no copay and a 20% coinsurance for contact lenses, up to a $175 annual limit with no deductibles.
Dental Services See details
MVP Medicare Preferred Gold with Part D (HMO-POS) offers partially covered dental services, including Medicare-covered dental with a $40 copay and no coinsurance, and other dental services with no copay and no coinsurance up to a $1,500 annual maximum. While preventive, restorative, and surgical services are covered with no copay and no coinsurance, orthodontic services are not covered.
Home Infusion bundled Services See details
MVP Medicare Preferred Gold with Part D (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and other drugs, require no coinsurance to 20% coinsurance, while insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
MVP Medicare Preferred Gold with Part D (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Medical equipment is partially covered by MVP Medicare Preferred Gold with Part D (HMO-POS) with no copays, though prior authorization is required for services. Durable medical equipment carries a 20% coinsurance, prosthetic devices range from no coinsurance to 20% coinsurance, and diabetic therapeutic shoes have a 10% coinsurance, while medical supplies and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
MVP Medicare Preferred Gold with Part D (HMO-POS) partially covers diagnostic and radiological services, though lab services are not covered. Covered diagnostic procedures have a $15 copay with no coinsurance, while radiological services require prior authorization and carry a $40 copay for X-rays and diagnostic radiology, or a 20% minimum coinsurance for therapeutic radiology.
Home Health Services See details
MVP Medicare Preferred Gold with Part D (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
MVP Medicare Preferred Gold with Part D (HMO-POS) partially covers cardiac rehabilitation services, requiring prior authorization with a $20 copay and no coinsurance for additional cardiac rehabilitation services. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
MVP Medicare Preferred Gold with Part D (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior 3-day inpatient hospital stay is not required for admission, additional coverage beyond the standard Medicare-covered 100 days is not covered.
Other Services See details
MVP Medicare Preferred Gold with Part D (HMO-POS) covers acupuncture with no copay and 50% coinsurance for up to 12 treatments yearly, as well as meal benefits for chronic illness with no copay, no coinsurance, and prior authorization required. Over-the-counter (OTC) items are partially covered with no copay and no coinsurance up to $50 every three months, though Nicotine Replacement Therapy and Naloxone are not covered.
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