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MVP DualAccess Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MVP DualAccess Plus (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 Plus (HMO D-SNP) in 2025, please refer to our full plan details page.
MVP DualAccess Plus (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. The overall rating for this plan is not yet available for 2025.
It's important to know that MVP DualAccess Plus (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 Plus (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 Plus (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 Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $37.30. 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 Plus (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the cost-sharing amounts for drugs in each tier. The plan's formulary will provide details on which drugs are covered. If you qualify for the low-income subsidy (LIS), you may have a reduced premium. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The MVP DualAccess Plus (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying coinsurance amounts. You'll pay 20% coinsurance for services like emergency care, primary care visits, and durable medical equipment. The plan also provides coverage for preventive services, hearing and vision services, dental services, and home health services. This plan includes added benefits like coverage for home infusion services, dialysis, and diagnostic and radiological services, all with coinsurance requirements. In addition, this plan offers coverage for over-the-counter items and meal benefits. Some services, such as cardiac rehabilitation and additional hours of home health care, are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the MVP DualAccess Plus (HMO D-SNP) plan. However, additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services are covered under the MVP DualAccess Plus (HMO D-SNP) plan, including Outpatient Hospital Services and Observation Services with a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services with a minimum of 20% and a maximum of 20% coinsurance. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the MVP DualAccess Plus (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
For the MVP DualAccess Plus (HMO D-SNP) plan, Ambulance Services are covered with a 20% coinsurance for both ground and air ambulance services, and Transportation Services are covered for plan-approved health-related locations with 36 one-way trips per year, but transportation services to any health-related location are not covered. Prior authorization is required for both services.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the MVP DualAccess Plus (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 Plus (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, individual and group sessions for mental health and psychiatric services, and other health care professional visits each have a 20% coinsurance, while routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar preventive services, annual physical exams, and additional preventive services. Some additional services like In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a 20% coinsurance and a limit of one exam every year, and fitting/evaluation for hearing aids with no coinsurance. Prescription hearing aids are partially covered, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a 20% coinsurance, and eyewear benefits including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Routine eye exams and upgrades are not covered.
Dental Services See details
The MVP DualAccess Plus (HMO D-SNP) plan covers various dental services, including oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, with varying frequency limitations. Orthodontic services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the MVP DualAccess Plus (HMO D-SNP) plan, including Durable Medical Equipment with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment is covered with a 20% coinsurance for Medicare-covered Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic and radiological services; however, Lab Services are not covered. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services each have a coinsurance of at most 20%, and all other services have no copay.
Home Health Services See details
Home Health Services are covered by the MVP DualAccess Plus (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the MVP DualAccess Plus (HMO D-SNP) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but prior authorization is required. The plan charges the Medicare-defined cost share for tier 1, and there is no additional information about cost sharing provided. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The MVP DualAccess Plus (HMO D-SNP) plan covers Over-the-Counter (OTC) items with a maximum benefit of $75 every three months, 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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