A non-government entity
CDPHP Core (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CDPHP Core (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CDPHP Core (HMO) in 2026, please refer to our full plan details page.
CDPHP Core (HMO) is a HMO plan offered by Lifetime Healthcare, Inc. available for enrollment in 2025 to people living in Greater Capital Region of New York State. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that CDPHP Core (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about CDPHP Core (HMO).
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 CDPHP Core (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6100.00 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 CDPHP Core (HMO)
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Drug Coverage
Prescription drugs are not covered by CDPHP Core (HMO).
Additional Benefits
The CDPHP Core (HMO) plan offers affordable access to essential medical services, featuring no copay for primary care visits and low copays ranging from $0 to $25 for specialists. Emergency room visits require a $100 copay, while urgent care has a $50 copay, both with no coinsurance. For hospital stays, inpatient care carries a daily copay of $260 for the first six days and no copay thereafter, while outpatient hospital services require a $275 copay with no coinsurance. Members also benefit from comprehensive dental care with no copay up to a $1,250 annual maximum, alongside routine eye exams with no copay and a $250 annual eyewear allowance. Routine hearing exams are available with a copay of up to $25, and prescription hearing aids are covered with copays between $199 and $499. Additionally, the plan covers home health services, meals, and over-the-counter items with no copay, providing valuable everyday savings.
Inpatient Hospital See details
CDPHP Core (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a daily copay of $260 for days 1 through 6 and no copay for days 7 and beyond. Prior authorization and referrals are required for these services, and non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
CDPHP Core (HMO) covers outpatient services with no coinsurance, featuring a $275 copay for outpatient hospital and observation services, and a $225 copay for ambulatory surgical center services. Outpatient substance abuse services carry a $25 copay for individual or group sessions, while outpatient blood services are covered with no copay and no deductible.
Partial Hospitalization See details
CDPHP Core (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. A referral is required for some of these covered services.
Ambulance and Transportation Services See details
CDPHP Core (HMO) covers ambulance services with a $165 copay and no coinsurance for both ground and air transport. Transportation services are partially covered with no copay or coinsurance, offering unlimited round trips to plan-approved health-related locations, while transportation to any other health-related location is not covered.
Emergency Services See details
CDPHP Core (HMO) covers emergency services with a $100 copay (waived if admitted within 24 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency services are also covered with no coinsurance, requiring a $100 copay for emergency care, a $50 copay for urgent care, and a $165 copay for emergency transportation.
Primary Care See details
CDPHP Core (HMO) provides primary care physician services and opioid treatment with no copay and no coinsurance, while specialist, telehealth, psychiatric, and mental health services have copays ranging from $0 to $25 and no coinsurance. Physical, occupational, and speech therapies require a $25 copay with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by CDPHP Core (HMO) with no copay and no coinsurance for covered benefits, such as annual physical exams and health education. Sub-services that are not covered include 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, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing Services under CDPHP Core (HMO) are partially covered with no coinsurance, offering routine exams and fitting evaluations for a copay of up to $25. Up to two prescription hearing aids per year are covered with copays between $199 and $499, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription types are not covered.
Vision Services See details
CDPHP Core (HMO) offers partially covered vision services, featuring one routine eye exam per year with no copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered up to a $250 annual maximum with no copay, which includes a 20% coinsurance for contact lenses, though eyewear upgrades are not covered.
Dental Services See details
CDPHP Core (HMO) covers Medicare-covered dental services with a $25 copay and no coinsurance. Preventive and comprehensive dental services, including cleanings, x-rays, and restorative care, are covered with no copay and no coinsurance up to a maximum annual benefit of $1,250.
Home Infusion bundled Services See details
CDPHP Core (HMO) covers home infusion bundled services with prior authorization and step therapy required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, other Part B drugs require a $35 copay and 0% to 20% coinsurance, and chemotherapy drugs require a copayment and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the CDPHP Core (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
CDPHP Core (HMO) covers medical equipment, durable medical equipment (DME), and prosthetics with no copay and a 20% coinsurance up to $250 per item. Diabetic supplies require a $5 copay with no coinsurance, while diabetic therapeutic shoes and inserts have no copay and a 20% coinsurance up to $250.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under CDPHP Core (HMO) with prior authorization and referrals required. Outpatient diagnostic tests have a $0 to $25 copay and lab services have no copay, both with no coinsurance, while radiological services require a $25 copay plus coinsurance for X-rays, a $100 minimum copay for diagnostic imaging, and 20% coinsurance for therapeutic services.
Home Health Services See details
Home health services are covered under the CDPHP Core (HMO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by CDPHP Core (HMO), but only some services are covered. Standard cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered with no copay, while intensive cardiac rehabilitation is not covered with a 40% coinsurance.
Skilled Nursing Facility (SNF) See details
CDPHP Core (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $120 daily copay for days 21 through 100. Prior authorization and referrals are required, but a prior three-day hospital stay is not, and days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
CDPHP Core (HMO) covers other services including acupuncture, over-the-counter (OTC) items, and meal benefits. Acupuncture is provided with no copay and 50% coinsurance for up to 10 treatments annually, while OTC items and meals are covered with no copay and no coinsurance, featuring a $25 quarterly reimbursement limit for OTC products.
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