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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 2025, 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 4.5 out of 5 stars in 2025.
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 $40.80. 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 $590.00 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 $9350.00 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) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay the costs for your prescriptions. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for your Part D covered drugs. Your Part D premium is $40.80 per month.
Additional Benefits
The MVP DualAccess (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with copays or coinsurance for various services like primary care, hearing, vision, and dental. The plan also covers ambulance and transportation services, emergency services, and home health services, with varying cost-sharing amounts. Additional benefits include coverage for preventive services, hearing aids, and eyewear, along with coverage for medical equipment, diagnostic services, and skilled nursing facility services. The plan also offers over-the-counter (OTC) items, and a meal benefit. However, certain services such as podiatry, some hearing aids, and some vision services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered by the MVP DualAccess (HMO D-SNP) plan. The plan does not cover additional days, non-Medicare-covered stays, or upgrades for either Inpatient Hospital-Acute or Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services and observation services with a 20% coinsurance, and ambulatory surgical center services and outpatient substance abuse services, with a coinsurance between 20% and 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the MVP DualAccess (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MVP DualAccess (HMO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, and there is no copay. Transportation Services to a plan-approved health-related location are covered for up to 36 one-way trips per year, and transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the MVP DualAccess (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services is not covered.
Primary Care See details
The MVP DualAccess (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services (with 20% coinsurance), Occupational Therapy Services (with 20% coinsurance), Physician Specialist Services (with 20% coinsurance), Mental Health Specialty Services (with 20% coinsurance), Physical Therapy and Speech-Language Pathology Services (with 20% coinsurance), Additional Telehealth Benefits, and Opioid Treatment Program Services (with 20% coinsurance). Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero dollar preventive services, annual physical exams, health education, fitness benefits, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, and remote access technologies. In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a coinsurance of at most 20% and routine hearing exams limited to one per year, and fitting/evaluation for hearing aids which are unlimited. Prescription hearing aids (all types) are covered, limited to two every three years, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with 20% coinsurance, and eyewear with a combined maximum plan benefit of $200 every year, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Routine eye exams and upgrades are not covered.
Dental Services See details
The MVP DualAccess (HMO D-SNP) plan covers various dental services including oral exams, dental x-rays, and other diagnostic and preventive services. Orthodontics is not covered, and some services have limitations on the number of visits and periodicity.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and 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 DualAccess (HMO D-SNP) plan. This benefit requires prior authorization and has a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits are covered, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, Medicare-covered Prosthetic Devices, Medicare-covered Medical Supplies, Medicare-covered Diabetic Supplies, and Medicare-covered Diabetic Therapeutic Shoes or Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the MVP DualAccess (HMO D-SNP) plan. All diagnostic services and all radiological services have no copay, but you may be responsible for a coinsurance of at most 20% for diagnostic procedures/tests, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Lab services are not covered.
Home Health Services See details
Home Health Services are covered by the MVP DualAccess (HMO D-SNP) 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 Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for Cardiac Rehabilitation Services, and coinsurance information is available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MVP DualAccess (HMO D-SNP) plan, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items, with a maximum benefit coverage amount of $150 every month, and a meal benefit that requires prior authorization. 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 are not covered.
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