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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 2025, 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 2025.
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 $72.30. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $32.00. 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 $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) plan has a $590 deductible for prescription drugs. After you meet the deductible, you will pay the costs for your drugs based on the tier and pharmacy you use. Once your total drug costs reach $2000, you enter the next coverage phase. If you qualify for the low-income subsidy, your monthly premium for Part D will be $72.30. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered Part D drugs.
Additional Benefits
The Nascentia Skilled Nursing Facility (HMO I-SNP) plan covers a wide range of healthcare services. This plan includes inpatient hospital stays with prior authorization, outpatient services, and partial hospitalization, all with a 20% coinsurance. Emergency and urgently needed services are covered with a 20% coinsurance. The plan offers coverage for primary care, preventive services, hearing, vision, dental, and home infusion services. Many of these services require a 20% coinsurance, but some have specific copays or annual maximums. Additionally, the plan covers home health services with no copay or coinsurance, and provides coverage for medical equipment, and diagnostic and radiological services with a 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered; however, additional days, non-Medicare covered stays, and upgrades for both are not covered. The plan requires prior authorization for Inpatient Hospital-Acute.
Outpatient Services See details
Outpatient services include outpatient hospital services and observation services, both of which have a 20% coinsurance. Additionally, ambulatory surgical center (ASC) services and outpatient substance abuse services are covered with a coinsurance of 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Nascentia Skilled Nursing Facility (HMO I-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, and there is no copay. Transportation Services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency Services are covered, with a 20% coinsurance and no copay. Urgently Needed Services are also covered, with a 20% coinsurance and no copay. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Physician Specialist Services, and Additional Telehealth Benefits have a 20% coinsurance, while Chiropractic Services and Podiatry Services have a 20% coinsurance for routine care. Mental Health Specialty Services and Psychiatric Services have a 20% coinsurance for individual and group sessions, and Physical Therapy and Speech-Language Pathology Services also have a 20% coinsurance. Occupational Therapy Services has a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
The Nascentia Skilled Nursing Facility (HMO I-SNP) plan covers preventive services, including kidney disease education with a 20% coinsurance, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services include hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids, with a maximum benefit of $4,000 per year. Routine hearing exams, prescription hearing aids (inner ear, outer ear, and over the ear) and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams, eyewear, and upgrades. Eye exams have a 20% coinsurance, with routine eye exams covered once per year. Eyewear, including contact lenses, has a 20% coinsurance and a combined maximum of $800 per year, with contact lenses and eyeglasses (lenses and frames) covered once per year. Eyeglass lenses and frames are not covered.
Dental Services See details
The Nascentia Skilled Nursing Facility (HMO I-SNP) plan covers a range of dental services, including oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics. Fluoride treatment is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, both with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Nascentia Skilled Nursing Facility (HMO I-SNP) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME), prosthetics/medical supplies, and diabetic equipment. DME has a 20% coinsurance, while prosthetic devices and medical supplies have a 20% coinsurance. Diabetic supplies and therapeutic shoes/inserts also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-Ray services. Diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-Rays have a coinsurance of at most 20%, with no copay.
Home Health Services See details
Home Health Services are covered by the Nascentia Skilled Nursing Facility (HMO I-SNP) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is coinsurance for these 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, and coinsurance information is available in the plan details.
Other Services See details
Other Services, including acupuncture, over-the-counter items, meal benefits, and more, are not covered by the Nascentia Skilled Nursing Facility (HMO I-SNP) plan. This plan does not require authorization or a referral for these services.
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