A non-government entity
Centers Plan for Dual Coverage Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Centers Plan for Dual Coverage 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 Centers Plan for Dual Coverage Care (HMO D-SNP) in 2025, please refer to our full plan details page.
Centers Plan for Dual Coverage Care (HMO D-SNP) is a HMO D-SNP plan offered by Centers Plan for Healthy Living, LLC available for enrollment in 2025 to people living in NYC Metro Area, NASS, 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 Dual Coverage 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:
Centers Plan for Dual Coverage 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 Centers Plan for Dual Coverage 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 Centers Plan for Dual Coverage Care (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 $7650.00 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 Dual Coverage Care (HMO D-SNP) 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 $2000, at which point you will enter the next coverage phase. This plan's premium may be reduced if you qualify for the low-income subsidy, also known as LIS or "Extra help", with a premium of $72.30.
Additional Benefits
The Centers Plan for Dual Coverage Care (HMO D-SNP) offers a range of benefits, including coverage for outpatient services, with varying coinsurance rates. Emergency services, ambulance services, and home health services are covered with no copay, but coinsurance may apply. The plan also covers hearing and vision services, with a coinsurance for exams and coverage for hearing aids and eyewear. Additional benefits include dental services, medical equipment, and diagnostic services, all with varying coinsurance. The plan also provides coverage for home infusion services, dialysis services, and skilled nursing facilities. Other notable benefits include coverage for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but the specific costs for these services are not detailed in this summary. Additional days, non-Medicare covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, and outpatient substance abuse services have a minimum 20% coinsurance and maximum 20% coinsurance for individual and group sessions. Outpatient blood services have a deductible waived for three pints.
Partial Hospitalization See details
Partial Hospitalization is covered by the Centers Plan for Dual Coverage Care (HMO D-SNP) with prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay for ambulance services, but a 20% coinsurance for both ground and air ambulance services, which is waived if admitted to the hospital. Transportation services to a plan-approved health-related location are covered for 10 one-way trips every three months. Transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Centers Plan for Dual Coverage Care (HMO D-SNP) with a 20% coinsurance, and no copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services, with a 20% coinsurance. Chiropractic Services and Podiatry Services are covered with a 20% coinsurance, but Chiropractic Services require prior authorization and a doctor referral, and Podiatry Services require a doctor referral. Occupational Therapy Services, Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services are covered with a 20% coinsurance. Mental Health Specialty Services and Psychiatric Services are covered with a 20% coinsurance for individual and group sessions. Other Health Care Professional services are covered with a 20% coinsurance. Additional Telehealth Benefits and Opioid Treatment Program Services are also covered, but Opioid Treatment Program Services require prior authorization.
Preventive Services See details
Preventive Services include Medicare-covered preventive services with no copay, but annual physical exams are not covered. Additional preventive services such as health education, glaucoma screening, and barium enemas are covered, but many other services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a coinsurance of at most 20%, and prescription hearing aids with a maximum plan benefit of $2000 every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered. Routine hearing exams and fitting/evaluation for hearing aids are covered.
Vision Services See details
Vision services are covered, with a 20% coinsurance for eye exams. Eyewear is covered up to a combined maximum of $300 every year, and contact lenses and eyeglasses (lenses and frames) are also covered. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Centers Plan for Dual Coverage Care (HMO D-SNP) covers Medicare Dental Services with a 20% coinsurance. Other Dental Services including oral exams, dental x-rays, and other services are covered, but have visit limits and require prior authorization, while orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Centers Plan for Dual Coverage Care (HMO D-SNP) with prior authorization. You will pay a 20% coinsurance.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with a 20% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay and coinsurance applies, and Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic and radiological services, are covered. Diagnostic Procedures/Tests and Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while there is no copay. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered 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 Centers Plan for Dual Coverage Care (HMO D-SNP). Prior authorization is required for this benefit, but none of the sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. The plan requires prior authorization and charges the Medicare-defined cost share for tier 1.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items, with a maximum benefit of $250.00 per month, including nicotine replacement therapy and Naloxone. However, acupuncture, 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, and Self-Directed Personal Assistance Services are not covered.
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