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MVP DualAccess (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MVP DualAccess (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MVP DualAccess (HMO D-SNP) in 2026, please refer to our full plan details page.
MVP DualAccess (HMO D-SNP) is a HMO D-SNP plan offered by MVP Health Care, Inc. available for enrollment in 2025 to people living in Western NY, Eastern NY, Hudson Valley, NY. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that MVP DualAccess (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
MVP DualAccess (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about MVP DualAccess (HMO D-SNP).
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 DualAccess (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $54.60. 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 $615.00 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 $9250.00 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:
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Drug Coverage
The MVP DualAccess (HMO D-SNP) Medicare prescription plan features an annual drug deductible of $615. During the initial coverage phase, members pay a 25% coinsurance for prescription fills across Tier 1 preferred generics, Tier 2 generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs at standard pharmacies and standard mail order services. This 25% coinsurance also applies to Tier 5 specialty drugs for a one-month supply. For Tier 6 select care drugs, this plan offers no copay for one-month and three-month supplies filled at standard pharmacies or through standard mail order. Understanding these coinsurance rates and deductible costs can help you determine if the MVP DualAccess (HMO D-SNP) plan meets your health and budget needs.
Additional Benefits
The MVP DualAccess (HMO D-SNP) plan offers robust healthcare coverage with no copayments for most services, though many outpatient, specialist, and diagnostic treatments require a 20% coinsurance. Major services like inpatient hospital stays, skilled nursing facility care, and home health services are covered with no copay and no coinsurance, although some are subject to deductibles and prior authorization. Standard medical needs such as emergency care, ambulance services, and durable medical equipment also feature no copay alongside a 20% coinsurance. For supplemental care, members enjoy preventive services, comprehensive dental care, and prescription hearing aids with no copay and no coinsurance. Vision benefits include a routine annual exam and a $175 annual allowance for eyewear with no copay or coinsurance. Additionally, the plan provides valuable extra benefits to support daily wellness, including a $25 monthly over-the-counter allowance and up to 24 one-way transportation trips per year to approved health-related locations.
Inpatient Hospital See details
MVP DualAccess (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, subject to a deductible and prior authorization. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
MVP DualAccess (HMO D-SNP) covers outpatient services with no copayments, though a 20% coinsurance and prior authorization are required for outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Additionally, there is no deductible for outpatient blood services, with the deductible waived for the first three pints.
Partial Hospitalization See details
Partial hospitalization is covered by MVP DualAccess (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
MVP DualAccess (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
MVP DualAccess (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, with the emergency services coinsurance waived if you are admitted to the hospital within 24 hours. Worldwide emergency services, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
MVP DualAccess (HMO D-SNP) covers primary care, specialist, therapy, psychiatric, and opioid treatment services with no copay and 20% coinsurance, while additional telehealth benefits are offered with no copay and no coinsurance. Chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by MVP DualAccess (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Covered benefits include annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management. However, the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy-related hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, or counseling.
Hearing Services See details
Hearing services are partially covered by MVP DualAccess (HMO D-SNP), featuring routine hearing exams with no copay and a 20% coinsurance, and fitting evaluations with no copay. Prescription hearing aids are covered with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
MVP DualAccess (HMO D-SNP) partially covers vision services, offering one routine eye exam annually with no copay and a 20% coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $175 annual limit for contacts and eyeglasses, but upgrades are not covered.
Dental Services See details
Dental services are partially covered by MVP DualAccess (HMO D-SNP) with no copay and no coinsurance for preventive and comprehensive care, including cleanings, exams, and implants. While most diagnostic, restorative, and surgical treatments are covered, orthodontic services are not covered.
Home Infusion bundled Services See details
MVP DualAccess (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and other drugs, have no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by MVP DualAccess (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
MVP DualAccess (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and coverage for certain items may be limited to preferred brands or manufacturers.
Diagnostic and Radiological Services See details
MVP DualAccess (HMO D-SNP) partially covers diagnostic and radiological services with prior authorization required, though lab services are not covered. Covered services, including diagnostic procedures, radiological services, and outpatient X-rays, feature no copay and a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the MVP DualAccess (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
MVP DualAccess (HMO D-SNP) covers some cardiac rehabilitation services with no copay, though prior authorization is required. However, specific services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
MVP DualAccess (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. A three-day prior inpatient hospital stay is not required for admission, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
MVP DualAccess (HMO D-SNP) partially covers other services, offering a meal benefit for chronic illness (prior authorization required) and up to $25 per month for over-the-counter items with no copay and no coinsurance. Acupuncture, nicotine replacement therapy, and naloxone are not covered under these benefits.
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