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Senior Whole Health Medicare Complete Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Whole Health Medicare Complete Care (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 Medicare Complete Care (HMO D-SNP) in 2025, please refer to our full plan details page.
Senior Whole Health Medicare Complete Care (HMO D-SNP) is a HMO D-SNP plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Select Counties in New York. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Senior Whole Health Medicare Complete Care (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 Medicare Complete Care (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 Medicare Complete Care (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 Medicare Complete Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $12.50. 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 $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
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 Medicare Complete Care (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2,000. Once your yearly out-of-pocket drug costs reach $2,000, you will enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs. The plan's premium may be reduced if you qualify for the low-income subsidy, and the Part D premium would be $12.50.
Additional Benefits
The Senior Whole Health Medicare Complete Care (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, including outpatient, partial hospitalization, ambulance, emergency, primary care, vision, dental, dialysis, medical equipment, and diagnostic services, have a 20% coinsurance. Home health services have no copay or coinsurance, while home infusion has a copay for some drugs and coinsurance for others. This plan also covers hearing exams and eyewear with coinsurance, but excludes routine hearing exams and hearing aids. Additionally, some services like inpatient hospital, skilled nursing facility, and home infusion require prior authorization. The plan also offers acupuncture, over-the-counter items, and covers some prescription drugs.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, though additional days and non-Medicare-covered stays are not covered. Cost-sharing includes coinsurance, and prior authorization is required for both.
Outpatient Services See details
Outpatient services are covered, with 20% coinsurance for outpatient hospital services and observation services. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are also covered, with a minimum of 20% and a maximum of 20% coinsurance for individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Senior Whole Health Medicare Complete Care (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, including ground and air ambulance services, each with a 20% coinsurance. Transportation Services to any health-related location are covered, including rideshares, buses, and medical transport.
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 the Senior Whole Health Medicare Complete Care (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, and there is no copay. Worldwide Emergency Services has a maximum benefit coverage of $10,000.
Primary Care See details
The Senior Whole Health Medicare Complete Care (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services, with a 20% coinsurance for most services. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services are covered, but annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, and support for caregivers of enrollees are not covered. Additional services such as Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing services are partially covered by the Senior Whole Health Medicare Complete Care (HMO D-SNP) plan, with hearing exams covered at a coinsurance of at most 20%. However, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types, inner ear, outer ear, and over the ear) are not covered.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance, and eyewear with a 20% coinsurance and a combined maximum benefit of $285. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames and upgrades are also covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance. Other dental services include 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, maxillofacial prosthetics, implant services, prosthodontics, fixed, and oral and maxillofacial surgery, but Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance ranges from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Senior Whole Health Medicare Complete Care (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Senior Whole Health Medicare Complete Care (HMO D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while all diagnostic and radiological services have no copay.
Home Health Services See details
Home Health Services are covered by the Senior Whole Health Medicare Complete Care (HMO D-SNP) plan, with no copay or coinsurance, but prior 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 Medicare Complete Care (HMO D-SNP) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Senior Whole Health Medicare Complete Care (HMO D-SNP) plan, but the cost sharing details are not provided in this snippet. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered. Prior authorization is required.
Other Services See details
The Senior Whole Health Medicare Complete Care (HMO D-SNP) plan covers acupuncture with a limit of 30 treatments per year, and also covers over-the-counter items, including nicotine replacement therapy and Naloxone. This plan does not cover meal benefits, 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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