A non-government entity
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 2026, 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 out of 5 stars in 2026.
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 $58.80. 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 $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:
Sign up for MVP DualAccess Complete (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The MVP DualAccess Complete (HMO D-SNP) Medicare plan features an annual drug deductible of $615. During the initial coverage phase, members pay a 25% coinsurance for prescription drugs in Tiers 1 through 5 when using standard pharmacies or standard mail order services. This 25% coinsurance applies to Tier 1 preferred generics, Tier 2 generics, Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs. For Tier 6 select care drugs, this plan offers no copay for one-month and three-month supplies filled through standard pharmacies or standard mail order. This straightforward cost structure helps beneficiaries easily manage their medication expenses under the MVP DualAccess Complete (HMO D-SNP) plan.
Additional Benefits
The MVP DualAccess Complete (HMO D-SNP) plan offers comprehensive medical coverage with no copays or coinsurance for inpatient hospital stays, preventive care, and home health services. For outpatient services, specialist visits, emergency care, and medical equipment, members will generally pay no copay and a 20% coinsurance. Skilled nursing facility stays are also covered with no copay and no coinsurance for Medicare-covered days, though prior authorization is frequently required. Beyond standard medical care, the plan features additional benefits like preventive and comprehensive dental services with no copay and no coinsurance. Members also receive routine vision and hearing coverage, including up to two hearing aids every three years and a $175 annual eyewear allowance with no copay. Other helpful perks include 24 one-way transportation trips to approved locations and a $25 monthly over-the-counter allowance with no copay.
Inpatient Hospital See details
MVP DualAccess Complete (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, subject to a deductible and prior authorization. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
MVP DualAccess Complete (HMO D-SNP) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services, with no copays and a 20% coinsurance. Prior authorization is required for these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by MVP DualAccess Complete (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
MVP DualAccess Complete (HMO D-SNP) covers ambulance services with a 20% coinsurance and no copay for both ground and air transport. Transportation services are partially covered with no copay or coinsurance, providing up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
MVP DualAccess Complete (HMO D-SNP) covers emergency services with a 20% coinsurance and no copay up to $115 per visit, with the coinsurance waived if admitted to the hospital within 24 hours. Urgently needed services are covered with a 20% coinsurance and no copay up to $40 per visit, while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
MVP DualAccess Complete (HMO D-SNP) covers primary care, specialist, therapy, mental health, and opioid treatment services with no copay and 20% coinsurance, while telehealth is available with no copay and no coinsurance. Chiropractic services are partially covered with no copay and 20% coinsurance, excluding routine and other chiropractic care, while podiatry services are not covered.
Preventive Services See details
MVP DualAccess Complete (HMO D-SNP) covers preventive services with no copay and no coinsurance, although prior authorization is required for most services. This benefit is partially covered, including annual physicals, health education, and memory fitness, but excluding services such as in-home safety assessments, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing services covered by MVP DualAccess Complete (HMO D-SNP) include routine hearing exams with no copay and a 20% coinsurance, and fitting evaluations with no copay. Prescription hearing aids are partially covered with no copay and no coinsurance for up to two aids every three years, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
MVP DualAccess Complete (HMO D-SNP) vision services are partially covered, offering one annual routine eye exam 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 yearly limit for contacts and glasses, but eyewear upgrades are not covered.
Dental Services See details
MVP DualAccess Complete (HMO D-SNP) provides partially covered dental services with no copay and no coinsurance for covered preventive and comprehensive care, though orthodontics is not covered. Prior authorization is required for many covered services, including dental x-rays, restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery.
Home Infusion bundled Services See details
MVP DualAccess Complete (HMO D-SNP) covers Home Infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs are covered with no copay and coinsurance ranging from no coinsurance to 20%. Covered Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by MVP DualAccess Complete (HMO D-SNP) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
MVP DualAccess Complete (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and certain items must be sourced from preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by MVP DualAccess Complete (HMO D-SNP), as lab services are not covered. Covered diagnostic procedures, x-rays, and radiological services require prior authorization and have no copay, but are subject to a 20% coinsurance.
Home Health Services See details
Home health services are covered by MVP DualAccess Complete (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided by MVP DualAccess Complete (HMO D-SNP) with no copay and require prior authorization, but only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered under this benefit and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
MVP DualAccess Complete (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay or coinsurance for Medicare-covered days, though prior authorization is required and additional days beyond the standard Medicare-covered limit are not covered. Beneficiaries can also be admitted to a skilled nursing facility with less than a three-day prior inpatient hospital stay.
Other Services See details
Other services are partially covered by MVP DualAccess Complete (HMO D-SNP), offering a $25 monthly over-the-counter (OTC) allowance and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered, and prior authorization is required for the meal benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved