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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 2025, 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, 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 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. Additionally, this plan comes with a Part B Premium reduction of $0.50. 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 $145.00 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 VNS Health EasyCare (HMO) plan has a $145 deductible for prescription drugs. After the deductible, you'll pay a copay depending on the drug tier and pharmacy. For example, you will pay a $20 copay for a preferred generic at a standard pharmacy, and a $47 copay for a standard generic at a standard pharmacy. For non-preferred drugs, you will pay 31% coinsurance. For specialty tier drugs, there is no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The VNS Health EasyCare (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Emergency services have a copay, and ambulance services are covered. Additionally, the plan includes coverage for primary care, specialist visits, and therapy services, all with copays. This plan also provides benefits for hearing, vision, and dental care, including exams, eyewear, and dental services with no copays for certain services. Other key benefits include home health services with no copay, skilled nursing facility care with a copay, and coverage for medical equipment and diagnostic services. The plan also covers acupuncture, over-the-counter items, and offers a meal benefit for chronic illness.
Inpatient Hospital See details
Inpatient Hospital benefits with VNS Health EasyCare (HMO) include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with prior authorization required. For Inpatient Hospital-Acute, there is a $400 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, there is a $300 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $200 copay, Observation Services with a $110 copay, Ambulatory Surgical Center (ASC) Services with a $200 copay, and Outpatient Substance Abuse Services with a copay of $35 for both individual and group sessions. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, and transportation to plan-approved health-related locations. Ground and air ambulance services have a copay of $250, and transportation services to any health-related location are limited to a maximum of $100 per round trip, up to 11 trips per year.
Emergency Services See details
Emergency Services are covered by VNS Health EasyCare (HMO), with a $110 copay for Emergency Services and a $45 copay for Urgently Needed Services, while Worldwide Emergency Coverage has a $110 copay and Worldwide Urgent Coverage has a $45 copay; Worldwide Emergency Transportation is not covered. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services are covered with a $15 copay, but routine care is not covered. Occupational Therapy Services have a $35 copay, and no coinsurance. Physician Specialist Services have a $35 copay. Mental Health Specialty Services are not covered. Podiatry Services, including routine foot care, are covered with a $25 copay. Psychiatric Services are covered with a $35 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $35 copay, with no coinsurance. Additional Telehealth Benefits are covered with a copay ranging from $0 to $200, and the plan also covers Opioid Treatment Program Services.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and additional preventive services, are covered. Fitness benefits, enhanced disease management, remote access technologies, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are also covered. However, health education, 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, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, 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 are not covered.
Hearing Services See details
Hearing exams, including routine exams and fitting/evaluation for hearing aids, are covered by the VNS Health EasyCare (HMO) plan. The plan also covers prescription hearing aids, with a maximum benefit of $750 per ear every three years, and over-the-counter (OTC) hearing aids with no limit on coverage.
Vision Services See details
The VNS Health EasyCare (HMO) plan covers eye exams, including routine eye exams and other eye exam services, with one exam allowed every year or two years, respectively. This plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $300 per year; however, upgrades are not covered.
Dental Services See details
The VNS Health EasyCare (HMO) plan offers a dental benefit with a maximum of $2,500 per year. This plan covers oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments, with no copay or coinsurance, but other diagnostic dental services are limited to 2 visits per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the VNS Health EasyCare (HMO) plan, but require prior authorization. Medicare Part B Insulin Drugs are covered.
Dialysis Services See details
Dialysis Services are covered by the VNS Health EasyCare (HMO) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered by the VNS Health EasyCare (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance with no copay, and requires authorization. Prosthetics/Medical Supplies - Non-Medicare benefits are covered, and have a coinsurance. Diabetic Equipment is covered, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, each with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a $50 copay, and Diagnostic Radiological Services with a copay of $110, and Therapeutic Radiological Services with 20% coinsurance. Outpatient X-Ray Services have a $15 copay, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the VNS Health EasyCare (HMO) 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 under the VNS Health EasyCare (HMO) 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 by VNS Health EasyCare (HMO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The VNS Health EasyCare (HMO) plan covers acupuncture with a limit of 20 treatments per year, and over-the-counter (OTC) items with a maximum benefit of $160 every three months; however, it does not cover Nicotine Replacement Therapy (NRT). The plan also offers a meal benefit for a chronic illness, but does not have a maximum benefit coverage amount. The plan does not cover dual eligible SNPs with highly integrated services, or the following 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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.
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