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Centers Plan for Medicaid Advantage Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Centers Plan for Medicaid Advantage Plus (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 Medicaid Advantage Plus (HMO D-SNP) in 2025, please refer to our full plan details page.
Centers Plan for Medicaid Advantage Plus (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, 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 Medicaid Advantage Plus (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 Medicaid Advantage Plus (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 Medicaid Advantage Plus (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 Medicaid Advantage Plus (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 $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 Medicaid Advantage Plus (HMO D-SNP) has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, you will pay $72.30. After your deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Centers Plan for Medicaid Advantage Plus (HMO D-SNP) offers a wide range of benefits. Outpatient, emergency, and primary care services are covered with a 20% coinsurance. The plan also includes coverage for hearing, vision, and dental services with coinsurance, and offers coverage for hearing aids with a maximum benefit. Additional benefits include no copays for ambulance, home health, and diagnostic services, and coverage for medical equipment, home infusion, and dialysis services, all with coinsurance. The plan also provides coverage for acupuncture and over-the-counter items, and requires prior authorization for some services, such as partial hospitalization, skilled nursing facilities, and dialysis services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, but the copay information is available separately. Additional days, non-Medicare covered stays, and upgrades for Inpatient Hospital-Acute and Additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and outpatient substance abuse services, are covered by the plan, with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services are also covered, both with a 20% coinsurance.
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, with no copay for ambulance services. Ground and air ambulance services have a 20% coinsurance, which is waived if admitted to the hospital, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, are covered with a 20% coinsurance, and no copay. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are not covered.
Primary Care See details
Primary Care services include coverage for 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. Chiropractic Services and Other Health Care Professional require prior authorization and a doctor referral, while Psychiatric Services require a doctor referral. Primary Care Physician Services, Physician Specialist Services, Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services, and Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance. Routine Chiropractic Care is not covered, and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, and additional preventive services, glaucoma screenings, barium enemas, digital rectal exams, and EKGs following a welcome visit, though health education and kidney disease education services are covered with prior authorization. Annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services includes routine hearing exams with a coinsurance of at most 20% and fitting/evaluation for hearing aids, with a limit of one visit every three years. Prescription hearing aids are covered, with a maximum benefit of $2000 every three years. However, 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 coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and include one routine eye exam per year. Eyewear, including contact lenses, also have a 20% coinsurance, and a combined maximum benefit of $300 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Centers Plan for Medicaid Advantage Plus (HMO D-SNP) covers Medicare Dental Services with 20% coinsurance. Other Dental Services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics, fixed, and oral and maxillofacial surgery, all of which require prior authorization, and are not unlimited. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including insulin and other Medicare Part B drugs. Medicare Part B Insulin Drugs have a $35 copay and 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Centers Plan for Medicaid Advantage Plus (HMO D-SNP), but require prior authorization. There is no information about cost-sharing for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetic Devices and Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment; however, 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 Medicaid Advantage Plus (HMO D-SNP) with no copay. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are covered with a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Centers Plan for Medicaid Advantage Plus (HMO D-SNP) with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Centers Plan for Medicaid Advantage Plus (HMO D-SNP). Prior authorization is required for this service.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Centers Plan for Medicaid Advantage Plus (HMO D-SNP), but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. The plan requires prior authorization and charges the Medicare-defined cost share for tier 1, but the specific copay and coinsurance are not detailed in this summary.
Other Services See details
The Centers Plan for Medicaid Advantage Plus (HMO D-SNP) covers acupuncture with a limit of 20 treatments per year, and also covers over-the-counter items with a maximum benefit of $340.00 every month. Other services such as meal benefits, and specific services like EPSDT, private duty nursing, and home and community based services are not covered.
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