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MVP Medicare Secure with Part D (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MVP Medicare Secure 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 Secure with Part D (HMO-POS) in 2025, please refer to our full plan details page.
MVP Medicare Secure 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 Secure 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 Secure 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 Secure with Part D (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $39.00. 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 $7900.00 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 Secure with Part D (HMO-POS)
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Drug Coverage
The MVP Medicare Secure with Part D (HMO-POS) plan has a $300 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, for a standard generic drug, you will pay a $47 copay. For preferred brand drugs, you pay 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs.
Additional Benefits
The MVP Medicare Secure with Part D (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and ambulance services. This plan also covers primary care, preventive services with no copay, and hearing, vision, and dental services with varying copays and coinsurance. Additional benefits include home health services with no copay and coverage for medical equipment and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization. For days 1-5, there is a $299 copay for each service, and for days 6-90, there is no copay. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a $350 copay, observation services with a $350 copay, ambulatory surgical center (ASC) services with a $300 copay, and outpatient substance abuse services with a $10 copay for both individual and group sessions. This plan also covers outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by the MVP Medicare Secure with Part D (HMO-POS) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $250 copay, and air ambulance services have a $500 copay; there is no coinsurance for either. Transportation Services to a plan-approved health-related location are covered for up to 12 one-way trips per year. 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 by the MVP Medicare Secure with Part D (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $35 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
The MVP Medicare Secure with Part D (HMO-POS) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $45 copay, mental health specialty services with a $10 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits, and opioid treatment program services with a $10 copay. The plan does not cover podiatry services, and routine chiropractic care is not covered.
Preventive Services See details
The MVP Medicare Secure with Part D (HMO-POS) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, health education, post-discharge in-home medication reconciliation, fitness benefits, remote access technologies, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, while services like in-home safety assessments, personal emergency response systems, and several others are not covered. Additional preventive services and kidney disease education services require prior authorization.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types), but do not cover prescription hearing aids for the inner ear, outer ear, and over the ear, or OTC hearing aids. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids is unlimited, while prescription hearing aids (all types) are covered twice per year with a copay between $699 and $999.
Vision Services See details
Vision services include eye exams with a $45 copay, and eyewear with 20% coinsurance for contact lenses. There is a maximum plan benefit coverage of $300 for eye exams and $225 for all eyewear.
Dental Services See details
Dental services are covered, with a $45 copay for Medicare Dental Services. Other dental services have a maximum plan benefit of $1750 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, but orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the MVP Medicare Secure with Part D (HMO-POS) plan. This benefit requires prior authorization and has a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by the MVP Medicare Secure with Part D (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Prosthetic Devices have a coinsurance between 0% and 20%; however, Durable Medical Equipment for use outside the home and Medical Supplies are not covered. Diabetic Therapeutic Shoes/Inserts have a 10% coinsurance, but Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with all diagnostic services requiring prior authorization. Diagnostic Procedures/Tests have a copay between $20.00 and $20.00, while Lab Services are not covered. Diagnostic Radiological Services have a copay between $50.00 and $225.00, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $50.00 copay.
Home Health Services See details
Home Health Services are covered by the MVP Medicare Secure with Part D (HMO-POS) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not the sub-services of Additional Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required, and there is a copay for the covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by MVP Medicare Secure with Part D (HMO-POS) with prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The MVP Medicare Secure with Part D (HMO-POS) plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. Over-the-counter items are covered with a maximum benefit of $75 every three months, and meal benefits are covered with prior authorization.
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