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VNS Health Total (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for VNS Health Total (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on VNS Health Total (HMO D-SNP) in 2025, please refer to our full plan details page.
VNS Health Total (HMO D-SNP) is a HMO D-SNP plan offered by Visiting Nurse Service of New York available for enrollment in 2025 to people living in NYC, Albany, Buffalo and Rochester Metro Areas. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that VNS Health Total (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:
VNS Health Total (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 VNS Health Total (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 VNS Health Total (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $72.30. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced 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
We don't have information on the Maximum Out-Of-Pocket cost for this plan. You can call our licensed insurance specialists by clicking "Call to Enroll" below for more information.
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 VNS Health Total (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your prescriptions. Once your total drug costs reach $2000, you will enter the next coverage phase. If you qualify for the low-income subsidy, your Part D premium will be $72.30. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The VNS Health Total (HMO D-SNP) plan offers a wide range of benefits with no copay, including ambulance services, emergency services, home health services, dialysis services, and diagnostic and radiological services. The plan also covers hearing exams, prescription hearing aids, and OTC hearing aids, as well as vision and dental services. Other benefits include coverage for outpatient services, partial hospitalization, and medical equipment. The plan provides additional benefits such as acupuncture, an over-the-counter (OTC) allowance, and a meal benefit for chronic illnesses. Primary care, preventive services, and skilled nursing facility services are also covered. However, certain services like cardiac rehabilitation, private duty nursing, and additional hours of care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days for Inpatient Hospital-Acute is covered, but Additional Days for Inpatient Hospital Psychiatric is not covered.
Outpatient Services See details
Outpatient Services are covered by the VNS Health Total (HMO D-SNP) plan, including outpatient hospital services, observation services, and ambulatory surgical center (ASC) services. The plan does not cover individual sessions for outpatient substance abuse, group sessions for outpatient substance abuse, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information about the cost of this benefit.
Ambulance and Transportation Services See details
The VNS Health Total (HMO D-SNP) plan covers ambulance services with no copay and no coinsurance, but ground and air ambulance services are not covered. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered with no copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The VNS Health Total (HMO D-SNP) plan covers Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Podiatry Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services, Mental Health Specialty Services, and Psychiatric Services require prior authorization, and Routine Chiropractic Care, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, and Group Sessions for Psychiatric Services are not covered.
Preventive Services See details
The VNS Health Total (HMO D-SNP) plan covers preventive services, including Medicare-covered services with no copay, and additional preventive services that are not usually covered by Medicare. The plan does not cover annual physical exams, health education, in-home safety assessments, Personal Emergency Response Systems (PERS), medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, readmission 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, telemonitoring services, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
The VNS Health Total (HMO D-SNP) plan covers hearing exams, including routine hearing exams once per year and fitting/evaluation for hearing aids twice every three years. This plan also covers prescription hearing aids, with a maximum benefit of $1,000 per ear every three years, and covers OTC hearing aids with no limit on coverage.
Vision Services See details
The VNS Health Total (HMO D-SNP) plan covers vision services, including routine eye exams with one visit every year and other eye exam services with one visit every two years. Eyewear is covered with a combined maximum benefit of $350 every year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames (1 of each, every year); however, upgrades are not covered.
Dental Services See details
VNS Health Total (HMO D-SNP) offers dental services with a maximum plan benefit of $3,500 every year, covering oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment with no copay or coinsurance. Other covered dental services include Other Diagnostic Dental Services (2 visits per year), Restorative Services (2 visits per year), Prosthodontics, removable (2 visits per year), Implant Services (1 visit every three years), Prosthodontics, fixed (2 visits per year), and Oral and Maxillofacial Surgery (2 visits per year), with all of these services requiring prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the VNS Health Total (HMO D-SNP) plan, with prior authorization required. Insulin benefits, including Medicare Part B Insulin Drugs, are also covered. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by the VNS Health Total (HMO D-SNP) plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
The Medical Equipment benefit covers Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, with no copay or coinsurance for DME and Prosthetics/Medical Supplies. However, Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for the covered services.
Home Health Services See details
Home Health Services are covered by the VNS Health Total (HMO D-SNP) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the VNS Health Total (HMO D-SNP) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
The VNS Health Total (HMO D-SNP) plan covers acupuncture, with a limit of 30 treatments per year. Over-the-counter (OTC) items are covered up to $310.00 monthly, and the plan provides a meal benefit for chronic illnesses. However, 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, 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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