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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 S.Tier NY, CNY, Eastern NY, Hudson Valley NY. 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 comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient and outpatient services, with copays varying by service, and offers no copay for home health services. Additional benefits include hearing, vision, and dental services, with specific copays and coverage limits for each. The plan also covers ambulance, emergency, and primary care services, and offers coverage for medical equipment and diagnostic services, with coinsurance applying to certain services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization. For both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric stays, there is a $375 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered. Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a $350 copay, observation services with a $350 copay, ambulatory surgical center services with a $250 copay, and outpatient substance abuse services with a $30 copay. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the MVP Medicare Preferred Gold without Part D (HMO-POS) plan. This benefit requires prior authorization and has a $30 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $200 copay, and air ambulance services have a $400 copay, with no coinsurance. Transportation Services to a plan-approved health-related location are covered for 12 one-way trips per year.
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, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay (except for Worldwide Emergency Transportation which has a $200 copay), and Urgently Needed Services has a $45 copay; all services have no coinsurance.
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 have a $15 copay, while Individual and Group Sessions for Mental Health and Psychiatric Services have a $30 copay. Physical Therapy and Speech-Language Pathology Services have a $20 copay. Other Health Care Professional services have a copay between $0 and $40.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, health education, Post discharge In-Home Medication Reconciliation, fitness benefits, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Additional services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, re-admission prevention, wigs for hair loss, 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, additional smoking cessation counseling, enhanced disease management, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing Services are covered, including routine hearing exams and fitting/evaluation for hearing aids, with no deductible. Routine hearing exams are limited to one per year. 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 also not covered.
Vision Services See details
Vision services include eye exams with a $30 copay and eyewear with 20% coinsurance; contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered. There is a maximum plan benefit coverage of $300.00 for eye exams and $150.00 for eyewear.
Dental Services See details
Dental services include coverage for Medicare dental services with a $30 copay, along with other services, up to a maximum of $1000 per year, 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 and fixed), maxillofacial prosthetics, implant services, 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, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0-20%. For the other drug services, there is a coinsurance between 0-20%.
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 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics with 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with 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. Diagnostic Procedures/Tests have a copay of $10, while Lab Services are not covered. Diagnostic Radiological Services have a copay between $50 and $200, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have a copay of $50.
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 under the MVP Medicare Preferred Gold without Part D (HMO-POS) plan. Prior authorization is required for coverage, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MVP Medicare Preferred Gold without Part D (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a 50% coinsurance and is limited to 10 treatments per year, while OTC items are covered up to $25 every three months. The meal benefit requires prior authorization, and all other listed services are not covered.
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