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MVP DualAccess Complete (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MVP DualAccess Complete (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 Complete (HMO D-SNP) in 2025, please refer to our full plan details page.
MVP DualAccess Complete (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 Complete (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 Complete (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 Complete (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 Complete (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $45.00. 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 $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 Complete (HMO D-SNP) plan has a $590.00 deductible for prescription drugs. Once the deductible is met, you'll pay the costs for your medications based on the drug tier and pharmacy you use until your total drug costs reach $2000.00. After this, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The MVP DualAccess Complete (HMO D-SNP) plan offers a variety of benefits with a focus on outpatient services. Many services such as outpatient services, emergency services, primary care, preventive services, vision, and home health services have no copay. Most services have a 20% coinsurance, including outpatient services, emergency services, primary care, vision, dental, medical equipment, and diagnostic services. The plan also covers hearing services, prescription hearing aids, and a combined maximum of $200 per year for eyewear. Additionally, the plan offers coverage for home infusion, dialysis, and skilled nursing facilities, though some services require prior authorization and have coinsurance. Other services, such as over-the-counter items and meal benefits are also covered, with some limitations.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization, but specific cost-sharing details like copay and coinsurance are not available. Additional days, non-Medicare covered stays, and upgrades for Inpatient Hospital-Acute, as well as 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 and Observation Services, each with a 20% coinsurance, as well as Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services, both with a coinsurance of 20%. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance. The plan also covers transportation to plan-approved health-related locations, with 36 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the MVP DualAccess Complete (HMO D-SNP) plan. Emergency Services have a 20% coinsurance, while Urgently Needed Services also have a 20% coinsurance; both have no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The MVP DualAccess Complete (HMO D-SNP) plan covers primary care physician services, chiropractic 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. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, and other health care professional services have a 20% coinsurance. Mental health specialty services and psychiatric services have a minimum coinsurance of 20% and a maximum coinsurance of 20%. Occupational therapy and opioid treatment program services have a minimum coinsurance of 20% and a maximum coinsurance of 20%. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The MVP DualAccess Complete (HMO D-SNP) plan covers preventive services including annual physical exams, health education, kidney disease education, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. The plan also offers a fitness benefit, and remote access technologies with no copay or coinsurance. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a coinsurance of at most 20%, routine hearing exams (1 per year), and fitting/evaluation for hearing aids. Prescription Hearing Aids (all types) are covered up to 2 every three years, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services are covered, with a 20% coinsurance for eye exams, while routine eye exams and upgrades are not covered. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses, is covered with a combined maximum plan benefit of $200 per year.
Dental Services See details
Dental services are covered, 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, with prior authorization required. 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 Complete (HMO D-SNP) plan, but prior authorization is required. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment, also with a 20% coinsurance for some services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the MVP DualAccess Complete (HMO D-SNP) plan, with no copay or coinsurance; however, Additional Hours of Care and Personal Care Services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and coinsurance applies.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but the coinsurance details are not provided. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required.
Other Services See details
Other Services include coverage for over-the-counter items with a maximum benefit of $175.00 every month, and meal benefits that require prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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