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Senior Whole Health of New York NHC (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Whole Health of New York NHC (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Senior Whole Health of New York NHC (HMO D-SNP) in 2025, please refer to our full plan details page.
Senior Whole Health of New York NHC (HMO D-SNP) is a HMO D-SNP plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Counties: Ki, Qu, Brx, NY, Wes, and Na. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Senior Whole Health of New York NHC (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:
Senior Whole Health of New York NHC (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 Senior Whole Health of New York NHC (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 Senior Whole Health of New York NHC (HMO D-SNP), 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.
This plan has a $540.00 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 Senior Whole Health of New York NHC (HMO D-SNP) plan has a $540 deductible for prescription drugs. After meeting the deductible, you will pay 25% coinsurance for most drugs at standard pharmacies and mail order. This plan offers an enhanced alternative drug benefit. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Senior Whole Health of New York NHC (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying coinsurance costs. The plan provides coverage for emergency services, primary care, preventive services, hearing, vision, and dental, with some services requiring coinsurance and prior authorization. This plan also includes coverage for home health services, home infusion, and dialysis services, as well as medical equipment and diagnostic services, with various cost-sharing arrangements.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days for inpatient hospital and non-Medicare-covered stays are not covered. The plan's cost-sharing follows the original Medicare guidelines, with coinsurance amounts available upon request.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services. Outpatient Hospital Services and Observation Services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a coinsurance between 20% and 20%. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Senior Whole Health of New York NHC (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Senior Whole Health of New York NHC (HMO D-SNP), with a 20% coinsurance for both ground and air ambulance services; transportation services to any health-related location are covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered by Senior Whole Health of New York NHC (HMO D-SNP). Emergency Services and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services has a maximum benefit coverage of $10,000.
Primary Care See details
The Senior Whole Health of New York NHC (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Most services have a 20% coinsurance, while routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero dollar preventive services, health education, additional sessions of smoking and tobacco cessation counseling (8 visits), fitness benefits (physical and memory fitness), remote access technologies, kidney disease education services, and other preventive services with a 20% coinsurance. Annual physical exams, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), 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, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services are partially covered by the Senior Whole Health of New York NHC (HMO D-SNP) plan, with a coinsurance of at most 20% for hearing exams. However, routine hearing exams, fitting/evaluation for hearing aids, and all prescription hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are covered once per year. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, also have a 20% coinsurance, with a combined maximum plan benefit of $350 per year.
Dental Services See details
Dental services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services with no maximum plan benefit. Other dental services include coverage for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery, but orthodontics is 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 a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Senior Whole Health of New York NHC (HMO D-SNP) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment has a 20% coinsurance, and requires authorization. Prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes/inserts all have a 20% coinsurance. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for any services. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Senior Whole Health of New York NHC (HMO D-SNP) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Senior Whole Health of New York NHC (HMO D-SNP) plan. Prior authorization is required for this benefit if covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered or non-Medicare-covered stays. Prior authorization is required, and you will have a copay.
Other Services See details
Under the Senior Whole Health of New York NHC (HMO D-SNP) plan, acupuncture is covered up to 30 treatments per year, while over-the-counter items are covered, including nicotine replacement therapy and Naloxone. Other services such as meal benefits, and home and community based services are not covered.
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