A non-government entity
VNS Health EasyCare (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for VNS Health EasyCare (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on VNS Health EasyCare (HMO) in 2026, please refer to our full plan details page.
VNS Health EasyCare (HMO) is a HMO plan offered by Visiting Nurse Service of New York available for enrollment in 2025 to people living in NYC Metro, Upstate and Western NY. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that VNS Health EasyCare (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about VNS Health EasyCare (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 VNS Health EasyCare (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.00. 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 $500.00 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:
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Drug Coverage
The VNS Health EasyCare (HMO) prescription drug plan features an annual drug deductible of $500. Under this plan, members enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies or through standard mail order. This coverage structure helps lower your out-of-pocket expenses for many common and essential medications. For other prescription tiers, standard pharmacy copays for a one-month supply are $20 for Tier 2 generics, $47 for Tier 3 preferred brands, and $100 for Tier 4 non-preferred brands. Tier 5 specialty medications require a 27% coinsurance for a one-month supply at standard pharmacies. Multi-month supplies are also available for Tiers 2, 3, and 4 to help you conveniently manage long-term prescription costs.
Additional Benefits
The VNS Health EasyCare (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialized care, members pay a $35 copay for specialist visits and a $200 copay for outpatient hospital services. Inpatient hospital stays require a $400 daily copay for the first five days, after which there is no copay, while emergency room visits carry a $115 copay. This plan also includes valuable supplemental benefits, such as dental care up to a $2,500 annual limit, a $300 yearly vision hardware allowance, and hearing aid coverage up to $750 per ear, all with no copays or coinsurance. Additionally, members benefit from no copays for up to 11 round-trip transportation rides per year and a $107 quarterly allowance for over-the-counter products. For major needs like dialysis and durable medical equipment, members can expect a 20% coinsurance with no copay.
Inpatient Hospital See details
VNS Health EasyCare (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $400 copay for days 1 to 5 and no copay for days 6 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are also covered with no coinsurance, featuring a $300 copay for days 1 to 5 and no copay for days 6 to 90. Both benefits require prior authorization, and additional psychiatric days or non-Medicare-covered stays are not covered.
Outpatient Services See details
VNS Health EasyCare (HMO) covers outpatient services with no coinsurance, including outpatient hospital and ambulatory surgical center services for a $200 copay. Observation services require a $110 copay per stay, outpatient substance abuse sessions have a $35 copay, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the VNS Health EasyCare (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by VNS Health EasyCare (HMO) with prior authorization, featuring a $250 copay and no coinsurance for ground and air ambulance rides. Transportation is partially covered with no copay or coinsurance for up to 11 round trips per year (up to $100 per trip) to plan-approved locations, but transportation to any other health-related location is not covered.
Emergency Services See details
VNS Health EasyCare (HMO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum limit with matching copays and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
VNS Health EasyCare (HMO) offers primary care, other healthcare professional, and opioid treatment services with no copay and no coinsurance. Specialist visits, psychiatric care, and physical, occupational, and speech therapies require a $35 copay and no coinsurance, while routine podiatry has a $25 copay and no coinsurance. Chiropractic and mental health specialty services are not covered.
Preventive Services See details
Preventive Services are partially covered by VNS Health EasyCare (HMO) with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and diabetes self-management. However, several additional preventive services are not covered, including health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, home modifications, and counseling.
Hearing Services See details
VNS Health EasyCare (HMO) covers hearing services with no copay and no coinsurance, including one routine hearing exam per year and two fitting evaluations every three years. Prescription hearing aids are partially covered up to $750 per ear every three years, excluding inner ear, outer ear, and over-the-ear models, while over-the-counter (OTC) hearing aids are covered with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by VNS Health EasyCare (HMO) with no copay and no coinsurance, featuring one routine eye exam per year and a $300 annual limit for eyeglasses or contacts. While standard exams and eyewear are covered, eyewear upgrades are not covered.
Dental Services See details
VNS Health EasyCare (HMO) dental services are partially covered with no copay and no coinsurance for covered benefits, up to a $2,500 yearly maximum for comprehensive services. Sub-services that are not covered under this plan include other preventive services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
VNS Health EasyCare (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, insulin is covered with no copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs require a coinsurance of 0% to 20%.
Dialysis Services See details
VNS Health EasyCare (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
VNS Health EasyCare (HMO) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
VNS Health EasyCare (HMO) partially covers diagnostic and radiological services with prior authorization required, as lab services are not covered. Diagnostic tests require a $50 copay and no coinsurance, while radiological services require a $15 copay plus coinsurance for X-rays, a minimum $110 copay and no coinsurance for diagnostic radiology, and a copay with a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by VNS Health EasyCare (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by VNS Health EasyCare (HMO) with no coinsurance and a $20 copay, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by VNS Health EasyCare (HMO) with no coinsurance and no prior three-day hospital stay requirement. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though prior authorization is required and additional days are not covered.
Other Services See details
VNS Health EasyCare (HMO) partially covers other services with no copay and no coinsurance, including up to 20 annual acupuncture treatments, a chronic illness meal benefit, and a $107 quarterly over-the-counter allowance. Nicotine replacement therapy and other miscellaneous services are not covered.
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