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Nascentia Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Nascentia Dual Advantage (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 Dual Advantage (HMO D-SNP) in 2026, please refer to our full plan details page.
Nascentia Dual Advantage (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. This plan received an overall rating of 2.5 out of 5 stars in 2026.
It's important to know that Nascentia Dual Advantage (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 Dual Advantage (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 Dual Advantage (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 Dual Advantage (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 Dual Advantage (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan begins to cover its share of the costs. Because this is a Special Needs Plan, your actual out-of-pocket expenses may vary depending on the level of financial assistance you receive. Specific drug coverage tier details, including individual copayments and coinsurance rates, are not available for this plan. To determine your exact medication costs, it is best to review the plan's comprehensive formulary to see how your specific prescriptions are categorized.
Additional Benefits
The Nascentia Dual Advantage (HMO D-SNP) plan offers comprehensive medical coverage with no copays for most services, though many outpatient benefits require a 20% coinsurance. Essential services such as inpatient hospital stays, home health services, and skilled nursing facility care are fully covered with no copay and no coinsurance. For outpatient hospital visits, emergency services, specialist care, and diagnostic testing, members will pay no copay and a 20% coinsurance. Supplemental benefits are a key feature of this plan, highlighted by preventive and comprehensive dental care with no copay and no coinsurance. Vision benefits include a $350 annual eyewear allowance, while hearing services provide up to $2,000 annually for prescription hearing aids with no copay or coinsurance. Additionally, members receive a $225 monthly over-the-counter item allowance and covered diabetic equipment with no copay and no coinsurance.
Inpatient Hospital See details
Nascentia Dual Advantage (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, although prior authorization is required for acute care. This benefit is partially covered because additional stay days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Nascentia Dual Advantage (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital and ambulatory surgical center services, and there is no deductible for blood services.
Partial Hospitalization See details
Nascentia Dual Advantage (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Nascentia Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, which is not waived if you are admitted to the hospital. Transportation services are not covered under this plan.
Emergency Services See details
Emergency services under Nascentia Dual Advantage (HMO D-SNP) are partially covered, requiring a 20% coinsurance and no copay for emergency and urgent care, with the coinsurance waived if admitted to the hospital within one day. Worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Nascentia Dual Advantage (HMO D-SNP) covers primary care, specialist, therapy, mental health, psychiatry, and telehealth services with no copay and 20% coinsurance, while opioid treatment is covered with no copay and no coinsurance. Chiropractic services are partially covered with no copay and 20% coinsurance, excluding routine and other chiropractic care, while podiatry services are not covered.
Preventive Services See details
Nascentia Dual Advantage (HMO D-SNP) partially covers preventive services, offering Medicare-covered preventive screenings and memory fitness benefits with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, while annual physical exams and many supplemental benefits like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing Services are partially covered by Nascentia Dual Advantage (HMO D-SNP) with no copay, no coinsurance, and no deductible for covered fitting evaluations and prescription hearing aids up to a $2,000 annual limit. However, 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
Vision services are partially covered by Nascentia Dual Advantage (HMO D-SNP), offering no copay for covered services alongside a 20% coinsurance for routine eye exams and contact lenses. Up to $350 is covered annually for eyewear, though other eye exam services, individual eyeglass lenses, and individual eyeglass frames are not covered.
Dental Services See details
Dental services are covered by Nascentia Dual Advantage (HMO D-SNP), with Medicare-covered dental care requiring no copay and a 20% coinsurance. Preventive and comprehensive dental services, including cleanings, exams, and orthodontic care, are covered with no copay and no coinsurance, though comprehensive services require prior authorization.
Home Infusion bundled Services See details
Nascentia Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Nascentia Dual Advantage (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Nascentia Dual Advantage (HMO D-SNP) covers durable medical equipment and prosthetics or medical supplies with no copay and 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Nascentia Dual Advantage (HMO D-SNP) covers diagnostic and radiological services, including lab services, diagnostic procedures, therapeutic radiological services, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Home Health Services See details
Home Health Services are covered by Nascentia Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Nascentia Dual Advantage (HMO D-SNP) where some services are covered with no copay. However, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Nascentia Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though additional days beyond the Medicare-covered limit are not covered. Prior authorization is required, but the plan conveniently allows for admission without a prior three-day inpatient hospital stay.
Other Services See details
Nascentia Dual Advantage (HMO D-SNP) provides coverage for select other services with no copay and no coinsurance, including a $225 monthly over-the-counter item allowance and chronic illness meal benefits with prior authorization. Acupuncture, nicotine replacement therapy, and other additional services are not covered under this plan.
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