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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 2026, 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 2026.
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 $58.80. 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 $615.00 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) prescription drug coverage features an annual drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered prescription medications before the plan begins to cover its share of the costs. Specific drug coverage tier details, including individual copayments and coinsurance rates, are not available for this plan. To find out how your specific medications are covered, it is recommended to review the plan's formulary or contact the provider directly.
Additional Benefits
The Nascentia Medicaid Advantage Plus (HMO D-SNP) plan offers comprehensive coverage with no copay and no coinsurance for the vast majority of its covered services, including inpatient hospital stays, primary care, and home health care. Key exceptions include a $35 copay for Medicare Part B insulin, while ambulance and transportation services are entirely excluded from coverage. Beneficiaries can access robust dental coverage for preventive and comprehensive care with no copay, alongside an annual vision allowance of up to $800 and a hearing benefit maximum of $4,000. Additionally, the plan provides a generous monthly allowance of up to $428 for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Nascentia Medicaid Advantage Plus (HMO D-SNP) offers partially covered inpatient hospital services with no copay and no coinsurance for acute and psychiatric stays, though prior authorization is required for acute care. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Nascentia Medicaid Advantage Plus (HMO D-SNP) covers outpatient hospital, ambulatory surgical center, and outpatient blood services with no copay and no coinsurance. Some outpatient substance abuse services are covered with no copay or coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
Nascentia Medicaid Advantage Plus (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Nascentia Medicaid Advantage Plus (HMO D-SNP) does not cover ambulance and transportation services in practice, as ground ambulance, air ambulance, and health-related transportation services are all excluded. Consequently, there is no coverage, and no copays or coinsurance apply for these services under this plan.
Emergency Services See details
Nascentia Medicaid Advantage Plus (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. For worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Nascentia Medicaid Advantage Plus (HMO D-SNP) covers primary care, specialist, occupational therapy, physical and speech therapy, telehealth, and opioid treatment services with no copay and no coinsurance. Podiatry is not covered, and while some chiropractic, mental health, and psychiatric services are covered, routine and other chiropractic care, and individual or group sessions for mental health and psychiatric services, are not covered.
Preventive Services See details
Nascentia Medicaid Advantage Plus (HMO D-SNP) partially covers preventive services with no copay and no coinsurance for covered benefits like Medicare-covered preventive care, kidney disease education, glaucoma screenings, and diabetes self-management. However, the plan does not cover annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Nascentia Medicaid Advantage Plus (HMO D-SNP) offers partially covered hearing services with no copay, no coinsurance, and no deductible, up to a $4,000 annual maximum. While hearing exams and fitting evaluations are covered, routine hearing exams, OTC hearing aids, and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Nascentia Medicaid Advantage Plus (HMO D-SNP) with no copay, no coinsurance, and no deductible, offering one routine eye exam and up to $800 annually for eyeglasses or contact lenses. This benefit is partially covered, as other eye exam services, eyeglass lenses, and eyeglass frames are not covered.
Dental Services See details
Nascentia Medicaid Advantage Plus (HMO D-SNP) covers preventive and comprehensive dental services, including cleanings, exams, and orthodontic care, with no copay and no coinsurance. There is no maximum plan benefit limit, though prior authorization is required for comprehensive and orthodontic services.
Home Infusion bundled Services See details
Nascentia Medicaid Advantage Plus (HMO D-SNP) partially covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Medicare Part B insulin drugs are covered with a $35.00 copay and no coinsurance, but Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis services are covered by Nascentia Medicaid Advantage Plus (HMO D-SNP) with no copay and no coinsurance.
Medical Equipment See details
Nascentia Medicaid Advantage Plus (HMO D-SNP) covers durable medical equipment with no copay and no coinsurance, though prior authorization is required. For non-Medicare prosthetics, medical supplies, and diabetic equipment, some services are covered with no copay or coinsurance, but prosthetic devices, medical supplies, diabetic supplies, and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Nascentia Medicaid Advantage Plus (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. While some services are covered, diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the Nascentia Medicaid Advantage Plus (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Nascentia Medicaid Advantage Plus (HMO D-SNP) covers cardiac rehabilitation services with no copay and no coinsurance. Although some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Nascentia Medicaid Advantage Plus (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, but the plan does allow admission without a prior three-day inpatient hospital stay.
Other Services See details
Nascentia Medicaid Advantage Plus (HMO D-SNP) offers partially covered other services, with acupuncture and Nicotine Replacement Therapy (NRT) not covered. Covered services include meal benefits for chronic illnesses (prior authorization required) and over-the-counter (OTC) items with a $428 monthly maximum, both of which feature no copay and no coinsurance.
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