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Nascentia Medicaid Advantage Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Nascentia 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 Nascentia Medicaid Advantage Plus (HMO D-SNP) in 2025, please refer to our full plan details page.
Nascentia Medicaid Advantage Plus (HMO D-SNP) is a HMO D-SNP plan offered by VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK available for enrollment in 2025 to people living in Upstate New York. The overall rating for this plan is not yet available for 2025.
It's important to know that Nascentia 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:
Nascentia 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 Nascentia 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 Nascentia Medicaid Advantage Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $30.80. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $6.00. 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 $8500.00 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 Nascentia Medicaid Advantage Plus (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy, you will pay $30.80 for Part D. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs, but you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Nascentia Medicaid Advantage Plus (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, emergency services, primary care, and preventive services. Many services, such as ambulance, home health, and medical equipment, have no copay. The plan also covers hearing and vision services, with a yearly maximum benefit for hearing exams and eyewear, and dental services, which includes oral exams and other diagnostic services. Additional benefits include home infusion, dialysis, and diagnostic services, with no copay for these services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but additional days, non-Medicare covered stays, and upgrades for both are not covered. Prior authorization is required for Inpatient Hospital-Acute.
Outpatient Services See details
Outpatient Services are covered by the Nascentia Medicaid Advantage Plus (HMO D-SNP) plan. Outpatient Hospital Services and Observation Services are covered, as are Ambulatory Surgical Center (ASC) Services, but require prior authorization. Outpatient Substance Abuse Services are partially covered, as individual and group sessions are not covered, and Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Nascentia Medicaid Advantage Plus (HMO D-SNP) plan. The plan does not provide any additional details about the cost of the benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Nascentia Medicaid Advantage Plus (HMO D-SNP) plan, with no copay or coinsurance for all ambulance services. However, ground ambulance services, air ambulance services, transportation services to a plan-approved health-related location, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. There is no copay or coinsurance for Emergency Services and Urgently Needed Services. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care services are covered with no copay and no coinsurance for Occupational Therapy and Physical Therapy and Speech-Language Pathology Services. This plan does not cover Routine Chiropractic Care, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, and Group Sessions for Psychiatric Services.
Preventive Services See details
The Nascentia Medicaid Advantage Plus (HMO D-SNP) plan covers preventive services, including Medicare-covered preventive services. Annual physical exams, health education, 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, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. The plan also covers Kidney Disease Education Services and other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit.
Hearing Services See details
Hearing services include coverage for hearing exams, with a maximum benefit of $4,000 per year, and fitting/evaluation for hearing aids. Routine hearing exams, prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), and upgrades. Routine eye exams are covered once per year, and eyewear has a combined maximum benefit of $800 per year. Contact lenses and eyeglasses (lenses and frames) are covered once per year. Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
The Nascentia Medicaid Advantage Plus (HMO D-SNP) plan covers dental services, including oral exams (2 visits per year), dental x-rays (1 per year), other diagnostic dental services, prophylaxis (cleaning) (2 visits per year), fluoride treatments, other preventive dental services, and orthodontic services. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics all require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Insulin is covered with a $35 copay for Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by the Nascentia Medicaid Advantage Plus (HMO D-SNP) plan. There is no additional cost for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered by the Nascentia Medicaid Advantage Plus (HMO D-SNP) plan, with no copay or coinsurance for Durable Medical Equipment (DME) and Prosthetics/Medical Supplies - Non-Medicare benefit, but Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for the covered services.
Home Health Services See details
Home Health Services are covered by the Nascentia Medicaid Advantage Plus (HMO D-SNP) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the listed services are covered. This 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, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
The Other Services benefit for Nascentia Medicaid Advantage Plus (HMO D-SNP) covers over-the-counter items, with a maximum benefit of $300.00 every month, and meal benefits with prior authorization required. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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