A non-government entity
Centers Plan for Nursing Home Care (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Centers Plan for Nursing Home Care (HMO I-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 Nursing Home Care (HMO I-SNP) in 2025, please refer to our full plan details page.
Centers Plan for Nursing Home Care (HMO I-SNP) is a HMO I-SNP plan offered by Centers Plan for Healthy Living, LLC available for enrollment in 2025 to people living in NYC Metro, ER, NA, SU, RO, WE, NI, 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 Nursing Home Care (HMO I-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 Nursing Home Care (HMO I-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 Nursing Home Care (HMO I-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 Nursing Home Care (HMO I-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. Additionally, this plan comes with a Part B Premium reduction of $15.30. You must continue to pay paying your reduced 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 $7750.00 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 Nursing Home Care (HMO I-SNP) has a deductible of $590.00. After you meet your deductible, you will pay the costs for your drugs, but the specific amounts are not provided in this summary. Once your total drug costs reach $2,000.00, you will enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your Part D premium may be reduced to $72.30. After your yearly out-of-pocket drug costs reach $2,000.00, you will pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The Centers Plan for Nursing Home Care (HMO I-SNP) provides coverage for a variety of services with varying cost-sharing. Many services like primary care, home health, and diagnostic services have no copay, while others like outpatient services, emergency services, and ambulance services have a 20% coinsurance. The plan also offers hearing and vision benefits with limitations. This plan includes coverage for inpatient and outpatient services, with some services requiring prior authorization. It's important to note that certain services, such as cardiac rehabilitation, and some vision and dental services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered under the Centers Plan for Nursing Home Care (HMO I-SNP). However, additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric inpatient hospital services are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital and Observation Services have a 20% coinsurance, while Ambulatory Surgical Center Services and Outpatient Substance Abuse Services have a coinsurance of 20%. Outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Centers Plan for Nursing Home Care (HMO I-SNP) with a 20% coinsurance, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Centers Plan for Nursing Home Care (HMO I-SNP). Ground and air ambulance services have a 20% coinsurance, and there is no copay. Transportation services to a plan-approved health-related location are covered for 8 one-way trips per month via van, medical transport, or other means. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered with a 20% coinsurance, and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
Primary care physician services, occupational therapy services, physical therapy, and speech-language pathology services are covered with no coinsurance or copay. Chiropractic services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, and psychiatric services are covered with a 20% coinsurance. Opioid treatment program services are covered with prior authorization.
Preventive Services See details
Preventive Services are covered, with some services like the annual physical exam, in-home safety assessment, and others not covered. Kidney Disease Education Services and Diabetes Self-Management Training require prior authorization.
Hearing Services See details
Hearing Services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are covered once per year and once every three years, respectively. Prescription hearing aids are covered up to $1000 per ear every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services are partially covered under the Centers Plan for Nursing Home Care (HMO I-SNP), with no deductible. However, routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include oral exams, dental x-rays, and prophylaxis (cleaning), but fluoride treatments, orthodontic services, and other dental services are not covered. Oral exams, dental x-rays, and cleaning are limited to one visit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, both with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Centers Plan for Nursing Home Care (HMO I-SNP). There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Diabetic Equipment and Prosthetic Devices have a 20% coinsurance, and there is no copay for any of these services. 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 Centers Plan for Nursing Home Care (HMO I-SNP), with no copay. For Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, you pay at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Centers Plan for Nursing Home Care (HMO I-SNP) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Centers Plan for Nursing Home Care (HMO I-SNP). The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, or Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond those covered by Medicare and non-Medicare stays are not covered. This plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C.
Other Services See details
The "Centers Plan for Nursing Home Care (HMO I-SNP)" plan does not cover acupuncture, over-the-counter items, 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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