A non-government entity
Centers Plan for Medicare Advantage Care (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Centers Plan for Medicare Advantage Care (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Centers Plan for Medicare Advantage Care (HMO) in 2025, please refer to our full plan details page.
Centers Plan for Medicare Advantage Care (HMO) is a HMO plan offered by Centers Plan for Healthy Living, LLC available for enrollment in 2025 to people living in NYC Metro Area, ERIE, NASS, NIAG, ROCK Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Centers Plan for Medicare Advantage Care (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 Centers Plan for Medicare Advantage Care (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 Centers Plan for Medicare Advantage Care (HMO), 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 $395.00 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 $7550.00 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 Centers Plan for Medicare Advantage Care (HMO) has a $395.00 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions. For preferred generics, you will pay a $15 copay. Standard generics have a $47 copay. Preferred brand drugs have a $100 copay, and non-preferred drugs have a 25% coinsurance. After your total drug costs reach $2000.00, you will enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Centers Plan for Medicare Advantage Care (HMO) offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have a 20% coinsurance. Emergency services have a copay, and primary care visits have a $10 copay for many services. Preventive services are covered with no copay, as are home health services. The plan also includes hearing, vision, and dental benefits, with copays for exams and coverage for hearing aids, eyeglasses, and dental services. Additionally, the plan provides an allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered. For inpatient hospital acute care, you pay a $305 copay for days 1-6, and no copay for days 7-90; for inpatient hospital psychiatric care, you pay a $305 copay for days 1-5, and no copay for days 6-90. Additional days, non-Medicare stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, are covered with a 20% coinsurance, while Ambulatory Surgical Center (ASC) Services have a $250 copay. Outpatient Substance Abuse Services, including individual and group sessions, have a copay between $30 and $30.
Partial Hospitalization See details
Partial Hospitalization is covered under the Centers Plan for Medicare Advantage Care (HMO) with a $55 copay, but prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, with a $200 copay for each. Transportation Services to a plan-approved health-related location are covered for up to 10 one-way trips every three months, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Centers Plan for Medicare Advantage Care (HMO). Emergency Services and Worldwide Emergency Coverage have a $90 copay, and Urgently Needed Services have a $30 copay, with no coinsurance for any of these services. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered, but the plan covers up to $25,000 for Worldwide Emergency Services.
Primary Care See details
Primary Care services cover Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy, Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic services require prior authorization and a doctor referral, with a $10 copay for routine care. Occupational Therapy Services have a $10 copay, and Physician Specialist Services have a $10 copay. Mental Health Specialty Services, Psychiatric Services, and Other Health Care Professional services also have a $10 copay. Physical Therapy and Speech-Language Pathology Services have a $10 copay and require authorization. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero dollar preventive services, Health Education, Glaucoma Screening, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, but not for Annual Physical Exams, 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, Counseling Services, and Kidney Disease Education Services, and Diabetes Self-Management Training. Kidney Disease Education Services and Diabetes Self-Management Training require prior authorization.
Hearing Services See details
Hearing services include routine hearing exams with a $30 copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a maximum benefit of $2000 per ear every three years, while inner ear, outer ear, and over-the-ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $30 copay, and eyewear benefits, including contact lenses, eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Centers Plan for Medicare Advantage Care (HMO) offers dental services with a $30 copay for Medicare Dental Services. Other dental services include oral exams, dental x-rays, and prophylaxis (cleaning) with a limited number of visits, as well as fluoride treatment. Orthodontic services are covered up to a maximum of $2000 per year, but maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are 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 0-20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Centers Plan for Medicare Advantage Care (HMO) and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Centers Plan for Medicare Advantage Care (HMO), with a 20% coinsurance for Durable Medical Equipment (DME), Prosthetic Devices, and Medical Supplies, and no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Centers Plan for Medicare Advantage Care (HMO), with no copay for all services. Diagnostic Radiological Services and Therapeutic Radiological Services have a coinsurance of at most 20%, while Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Centers Plan for Medicare Advantage Care (HMO), with no copay or coinsurance, though 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 Centers Plan for Medicare Advantage Care (HMO). Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is no copay, and for days 21-100, there is a $160 copay.
Other Services See details
The Centers Plan for Medicare Advantage Care (HMO) provides an allowance of $50 per month for Over-the-Counter (OTC) items, including nicotine replacement therapy and Naloxone coverage, but acupuncture, meal benefits, and many other services are not covered.
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