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MVP Medicare WellSelect with Part D (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MVP Medicare WellSelect with Part D (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MVP Medicare WellSelect with Part D (PPO) in 2025, please refer to our full plan details page.
MVP Medicare WellSelect with Part D (PPO) is a PPO plan offered by MVP Health Care, Inc. available for enrollment in 2025 to people living in S.Tier NY, Central NY, Eastern NY. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that MVP Medicare WellSelect with Part D (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about MVP Medicare WellSelect with Part D (PPO).
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 MVP Medicare WellSelect with Part D (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $11.80. 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 $350.00 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 combined Maximum Out-Of-Pocket cost of $12000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $12000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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:
Sign up for MVP Medicare WellSelect with Part D (PPO)
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Drug Coverage
The MVP Medicare WellSelect with Part D (PPO) plan has a $350 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, for standard generics, you will pay a $15.00 copay. For preferred and standard brand drugs, and non-preferred drugs, you will pay 28% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The MVP Medicare WellSelect with Part D (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, outpatient services, and ambulance services. This plan also covers primary care, preventive services with no copay, and hearing and vision services with copays or coinsurance. Dental and home health services are covered, along with dialysis, medical equipment, and diagnostic services. Additional benefits include coverage for partial hospitalization, emergency services, and skilled nursing facilities. The plan also provides coverage for home infusion services and over-the-counter items. However, this plan does not cover cardiac rehabilitation services, and certain other services like acupuncture, personal care services, and orthodontics.
Inpatient Hospital See details
Inpatient Hospital coverage includes both acute and psychiatric care. For Inpatient Hospital-Acute, you pay a $425 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you pay a $400 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for both types of inpatient hospital care are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a $400 copay, observation services with a $400 copay, ambulatory surgical center services with a $300 copay, outpatient substance abuse services with a $10 copay for both individual and group sessions, and outpatient blood services. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the MVP Medicare WellSelect with Part D (PPO) plan. You will pay a $65 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance for any services. Ground ambulance services have a $300 copay, while air ambulance services have a $500 copay. Transportation services to a plan-approved health-related location are covered for 12 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $300 copay; there is no coinsurance for any of these services.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services are covered with a $15 copay. Routine Chiropractic Care is not covered. Podiatry Services are not covered.
Preventive Services See details
The MVP Medicare WellSelect with Part D (PPO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, health education, post-discharge in-home medication reconciliation, fitness benefits, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. This plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, with no deductible. Routine hearing exams are covered once per year. Prescription hearing aids (all types) are covered with a copay between $699 and $999, up to two per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $20 copay, and eyewear with 20% coinsurance for contact lenses. Eyewear has a combined maximum benefit of $225 every year.
Dental Services See details
Dental Services are covered, with a $45 copay for Medicare Dental Services. Other Dental Services have a maximum plan benefit of $1250 per year, and includes Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Oral and Maxillofacial Surgery. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the MVP Medicare WellSelect with Part D (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered by MVP Medicare WellSelect with Part D (PPO), including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 10% coinsurance. Medical Equipment for use outside the home, Medical Supplies, and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay of $30, while Lab Services are not covered. Diagnostic Radiological Services have a copay of at least $60, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have a $60 copay.
Home Health Services See details
Home Health Services are covered by the MVP Medicare WellSelect with Part D (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the MVP Medicare WellSelect with Part D (PPO) plan. Specifically, Additional Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MVP Medicare WellSelect with Part D (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day.
Other Services See details
The MVP Medicare WellSelect with Part D (PPO) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $50 every three months, and a meal benefit for chronic illnesses that requires prior authorization, but does not cover acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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