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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 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Senior Whole Health of New York NHC (HMO D-SNP) is a HMO D-SNP plan offered by Senior Whole Health of New York, Inc. available for the 2026 plan year to people living in Counties: Brx, Ki, Nas, NY, Or, Qu, Ric, Roc, West. CMS star rating not available for 2026.
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 $17.30. 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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 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 Senior Whole Health of New York NHC (HMO D-SNP)
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Drug Coverage
The Senior Whole Health of New York NHC (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This applies to one-month, two-month, and three-month supplies, helping you save on essential medications. For other drug tiers, costs are based on coinsurance rather than set copayments. Tier 2 generic drugs and Tier 3 preferred brand drugs both require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 30% coinsurance. Specialty medications in Tier 5 are covered with a 25% coinsurance for a one-month supply.
Additional Benefits
The Senior Whole Health of New York NHC (HMO D-SNP) plan offers comprehensive coverage where most medical services require no copays, though coinsurance applies to several outpatient and specialist services. Essential healthcare services, including inpatient hospital stays, skilled nursing facility care, and home health services, are fully covered with no copays and no coinsurance. However, outpatient procedures, emergency services, and specialist visits generally carry a 20% to 30% coinsurance. For supplemental benefits, members can access preventive dental care, over-the-counter hearing aids, and unlimited transportation to plan-approved locations with no copays and no coinsurance. Additionally, diagnostic testing, durable medical equipment, and routine vision care are covered with no copays and a 20% coinsurance.
Inpatient Hospital See details
Senior Whole Health of New York NHC (HMO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric care with no copay and no coinsurance, though prior authorization is required. Additional days, non-Medicare-covered stays, and upgrades are not covered under these services.
Outpatient Services See details
Outpatient services are covered by Senior Whole Health of New York NHC (HMO D-SNP) with no copays, but a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Senior Whole Health of New York NHC (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Senior Whole Health of New York NHC (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for unlimited one-way trips to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Senior Whole Health of New York NHC (HMO D-SNP) covers emergency and urgently needed services with a 30% coinsurance and no copay, which count toward the plan-level deductible. Worldwide emergency, urgent, and transportation services are also covered with no copay or coinsurance up to a maximum benefit limit of $10,000.
Primary Care See details
Senior Whole Health of New York NHC (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 30% coinsurance. Opioid treatment has no copay and 20% coinsurance, telehealth services have no copay and 20% to 30% coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Senior Whole Health of New York NHC (HMO D-SNP) covers Medicare-covered zero-dollar and additional preventive services, such as fitness benefits and health education, with no copay and no coinsurance. A 20% coinsurance and no copay apply to kidney disease education, glaucoma screenings, and diabetes training, while annual physical exams and several in-home support services are not covered.
Hearing Services See details
Senior Whole Health of New York NHC (HMO D-SNP) covers hearing exams with no copay, though routine exams require a 20% coinsurance. Over-the-counter hearing aids feature no copay and no coinsurance, and while prescription hearing aids also have no copay or coinsurance, only some services are covered as inner ear, outer ear, and over the ear devices are not covered.
Vision Services See details
Vision services are covered by Senior Whole Health of New York NHC (HMO D-SNP), though eye exams are only partially covered as other eye exam services are not covered. There is no copay or deductible, but a 20% coinsurance applies to routine eye exams (limited to one per year) and contact lenses, which are subject to a combined maximum eyewear benefit of $350 every year.
Dental Services See details
Dental services are partially covered by Senior Whole Health of New York NHC (HMO D-SNP), which offers Medicare-covered dental care with no copay and a 20% coinsurance. Other preventive and comprehensive dental services are covered with no copay and no coinsurance, although orthodontic services are not covered by the plan.
Home Infusion bundled Services See details
Senior Whole Health of New York NHC (HMO D-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Senior Whole Health of New York NHC (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Senior Whole Health of New York NHC (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and coverage for certain equipment and supplies is limited to preferred vendors and manufacturers.
Diagnostic and Radiological Services See details
Senior Whole Health of New York NHC (HMO D-SNP) covers diagnostic and radiological services, including lab services, tests, therapeutic radiology, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for all of these covered services.
Home Health Services See details
Senior Whole Health of New York NHC (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Senior Whole Health of New York NHC (HMO D-SNP) with no copay and require prior authorization, but some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Senior Whole Health of New York NHC (HMO D-SNP) covers skilled nursing facility (SNF) services with no copayment and no coinsurance, though prior authorization is required. While the plan does not require a prior three-day inpatient hospital stay for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Senior Whole Health of New York NHC (HMO D-SNP), offering up to 30 acupuncture treatments per year and over-the-counter items with no copay and no coinsurance. Meal benefits and highly integrated services for dual-eligible SNPs are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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