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RiverSpring MAP (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for RiverSpring MAP (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on RiverSpring MAP (HMO D-SNP) in 2025, please refer to our full plan details page.
RiverSpring MAP (HMO D-SNP) is a HMO D-SNP plan offered by RiverSpring Living Holding Corp. available for enrollment in 2025 to people living in Counties: Brx, Ki, Na, NY, Qu, Ri, Wes. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that RiverSpring MAP (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:
RiverSpring MAP (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 RiverSpring MAP (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 RiverSpring MAP (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $72.30. 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
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 $8900.00 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 RiverSpring MAP (HMO D-SNP) plan has a defined standard for drug coverage. The plan has a deductible of $590.00. If you qualify for the low-income subsidy (LIS), you'll pay $72.30 for Part D. After you pay your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The RiverSpring MAP (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, such as primary care, outpatient services, and emergency services, have a 20% coinsurance. There is no copay for ambulance services, emergency services, and home health services. The plan also covers preventive, hearing, vision, and dental services, as well as medical equipment, diagnostic services, and home infusion. Some benefits, like home health services, have no copay, while others, like hearing exams, require prior authorization. The plan also offers an over-the-counter (OTC) allowance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required, but additional days for either are not covered. The plan's cost sharing follows the Medicare-defined cost share for tier 1, with coinsurance details available, but upgrades and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient hospital services and observation services have a 20% coinsurance, and individual and group sessions for outpatient substance abuse have a coinsurance between 20% and 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial hospitalization is covered, 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 the RiverSpring MAP (HMO D-SNP) plan. All Ambulance Services are covered with a 20% coinsurance for both Ground and Air Ambulance Services, and there is no copay. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under the RiverSpring MAP (HMO D-SNP) plan with a 20% coinsurance, and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The RiverSpring MAP (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, and physical therapy and speech-language pathology services have a 20% coinsurance. Occupational therapy, mental health specialty services, psychiatric services, and opioid treatment program services have a minimum coinsurance of 20% and a maximum coinsurance of 20%. Podiatry services are not covered, and routine chiropractic care is not covered.
Preventive Services See details
The RiverSpring MAP (HMO D-SNP) plan covers preventive services, including Medicare-covered zero-dollar preventive services, with no copay or coinsurance. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with a 20% coinsurance. The plan does not cover annual physical exams, Health Education, In-Home Safety Assessment, Personal Emergency Response System (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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing Services are partially covered by the RiverSpring MAP (HMO D-SNP) plan, with hearing exams requiring prior authorization and a coinsurance of at most 20%. Prescription hearing aids and OTC hearing aids are not covered, and routine hearing exams and fitting/evaluation for hearing aids are also not covered.
Vision Services See details
Vision services are partially covered, with a 20% coinsurance for eye exams. Eyewear is also partially covered, with a 20% coinsurance for contact lenses.
Dental Services See details
Dental services are covered, including 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. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the RiverSpring MAP (HMO D-SNP) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs can range from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the RiverSpring MAP (HMO D-SNP) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Equipment, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, are covered with a 20% coinsurance, and 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 RiverSpring MAP (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, and 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 RiverSpring MAP (HMO D-SNP) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the RiverSpring MAP (HMO D-SNP) 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 the RiverSpring MAP (HMO D-SNP) plan, but require prior authorization. The plan charges the Medicare-defined cost share for tier 1 services, but does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays.
Other Services See details
Other Services include acupuncture, which has a 20% coinsurance after the deductible up to 30 treatments per year, and over-the-counter (OTC) items, which are covered up to $218.00 per month. The plan does not cover meal benefits, Dual Eligible SNPs with Highly Integrated 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, or Self-Directed Personal Assistance Services.
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