A non-government entity
Nascentia Skilled Nursing Facility (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Nascentia Skilled Nursing Facility (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Nascentia Skilled Nursing Facility (HMO I-SNP) in 2026, please refer to our full plan details page.
Nascentia Skilled Nursing Facility (HMO I-SNP) is a HMO I-SNP plan offered by VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK available for enrollment in 2025 to people living in Upstate New York. This plan received an overall rating of 2.5 out of 5 stars in 2026.
It's important to know that Nascentia Skilled Nursing Facility (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:
Nascentia Skilled Nursing Facility (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 Nascentia Skilled Nursing Facility (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 Nascentia Skilled Nursing Facility (HMO I-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 $6000.00 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 Skilled Nursing Facility (HMO I-SNP) prescription drug coverage includes an annual drug deductible of $615. This means you will need to pay $615 out of pocket for your covered medications before the plan begins to cover its portion of your prescription drug costs. Detailed information regarding specific drug tiers, copayments, and coinsurance is currently not available for this plan. To understand your exact out-of-pocket costs for specific medications under this Medicare Advantage plan, you should review the plan's complete formulary or contact the plan provider directly.
Additional Benefits
The Nascentia Skilled Nursing Facility (HMO I-SNP) offers comprehensive healthcare coverage featuring no copays for most medical services, which are typically paired with a 20% coinsurance. This cost-sharing structure applies to primary and specialist visits, outpatient hospital care, emergency services, and durable medical equipment. Additionally, home health care, skilled nursing facility stays, and standard preventive care are covered with no copay and no coinsurance. For supplemental care, the plan provides dental services and prescription hearing aids up to a $3,500 annual limit with no copay and no coinsurance. Vision care is also available with no copay and a 20% coinsurance, which includes a $700 annual allowance for covered eyewear. Prospective members should note that routine transportation, fitness benefits, and over-the-counter items are not covered under this plan.
Inpatient Hospital See details
Nascentia Skilled Nursing Facility (HMO I-SNP) partially covers inpatient hospital services, offering acute and psychiatric stays with no copay and Medicare-defined coinsurance. Prior authorization is required for acute care, and additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Nascentia Skilled Nursing Facility (HMO I-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for ambulatory surgical center and outpatient hospital services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Nascentia Skilled Nursing Facility (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Nascentia Skilled Nursing Facility (HMO I-SNP), offering Medicare-covered ground and air ambulance services with a 20% coinsurance and no copay. However, transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services and urgently needed services are covered by Nascentia Skilled Nursing Facility (HMO I-SNP) with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital within one day. 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 Skilled Nursing Facility (HMO I-SNP) covers primary care, specialist, mental health, therapy, and telehealth services with no copay and a 20% coinsurance, while opioid treatment is available with no copay and no coinsurance. Chiropractic services are not covered, and routine podiatry is limited to 12 visits per year with no copay and 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered by Nascentia Skilled Nursing Facility (HMO I-SNP), with Medicare-covered and other preventive services requiring no copay and no coinsurance, and kidney disease education requiring no copay and 20% coinsurance. Annual physical exams and additional services—including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, tobacco cessation, fitness benefits, disease management, telemonitoring, remote access, home safety modifications, and counseling—are not covered.
Hearing Services See details
Nascentia Skilled Nursing Facility (HMO I-SNP) provides partially covered hearing services with no copay and no coinsurance, up to a combined annual maximum of $3,500. While fitting evaluations and certain prescription hearing aids are covered, routine hearing exams, OTC hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Nascentia Skilled Nursing Facility (HMO I-SNP) partially covers vision services with no copays, featuring a 20% coinsurance for annual routine eye exams and contact lenses. The plan includes a $700 annual combined limit for covered eyewear, but individual eyeglass frames, individual lenses, and other eye exams are not covered.
Dental Services See details
Nascentia Skilled Nursing Facility (HMO I-SNP) dental services are partially covered, providing unlimited preventive, diagnostic, and comprehensive dental care with no copay and no coinsurance, though fluoride treatment is not covered. Prior authorization is required for comprehensive dental services, including restorative care, endodontics, periodontics, and implants.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Nascentia Skilled Nursing Facility (HMO I-SNP) with no copay, subject to prior authorization. Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Nascentia Skilled Nursing Facility (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Nascentia Skilled Nursing Facility (HMO I-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment, prosthetics, and medical supplies.
Diagnostic and Radiological Services See details
Nascentia Skilled Nursing Facility (HMO I-SNP) covers diagnostic and radiological services, including lab work, diagnostic tests, therapeutic radiology, and X-rays, with a 20% coinsurance and no copay. Prior authorization is required for all of these covered services.
Home Health Services See details
Nascentia Skilled Nursing Facility (HMO I-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Nascentia Skilled Nursing Facility (HMO I-SNP) with no copay, but in practice, some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. These excluded services require a 20% coinsurance and no copay.
Skilled Nursing Facility (SNF) See details
Nascentia Skilled Nursing Facility (HMO I-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Nascentia Skilled Nursing Facility (HMO I-SNP) indicates that some services are covered under the other services benefit, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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