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MVP Medicare WellSelect Plus with Part D (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MVP Medicare WellSelect Plus 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 Plus with Part D (PPO) in 2025, please refer to our full plan details page.
MVP Medicare WellSelect Plus with Part D (PPO) is a PPO plan offered by MVP Health Care, Inc. available for enrollment in 2025 to people living in Western NY (Rochester/Buffalo). This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that MVP Medicare WellSelect Plus 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 Plus 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 Plus with Part D (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $93.40. 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 $250.00 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 $11800.00 (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 $11800.00 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 Plus with Part D (PPO)
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Drug Coverage
The MVP Medicare WellSelect Plus with Part D (PPO) plan has a $250 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you'll pay a $12 copay for a preferred generic drug at a standard pharmacy, and 25% coinsurance for a preferred brand drug. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. Those who qualify for the low-income subsidy (LIS) may have their premium reduced to $29.70.
Additional Benefits
The MVP Medicare WellSelect Plus with Part D (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the service. This plan also covers preventive services with no copay, as well as vision and dental services with copays and coinsurance. Additionally, the plan provides coverage for hearing services, ambulance, and transportation services, along with home health and skilled nursing facility care, subject to certain copays and prior authorization requirements.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $400 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you pay a $400 copay for days 1-5, and no copay for days 6-90. Additional days and upgrades for Inpatient Hospital-Acute and Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for the MVP Medicare WellSelect Plus with Part D (PPO) plan includes coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital and Observation Services have a $375 copay, ASC Services have a $300 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay between $10 and $10.
Partial Hospitalization See details
Partial Hospitalization is covered under the MVP Medicare WellSelect Plus with Part D (PPO) plan, with a $50 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $225 copay, and air ambulance services have a $400 copay; there is no coinsurance for either service. Transportation Services to a plan-approved health-related location are covered for 12 one-way trips per year using various modes of transportation, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. Emergency Services have a $110 copay and no coinsurance, Urgently Needed Services have a $40 copay and no coinsurance, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, while Worldwide Emergency Transportation has a $225 copay.
Primary Care See details
The MVP Medicare WellSelect Plus with Part D (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $45 copay, mental health specialty services with a $10 copay for individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, and opioid treatment program services with a $10 copay. This plan also covers additional telehealth benefits, and other healthcare professional services with a copay between $0 and $45. Podiatry services are not covered.
Preventive Services See details
The MVP Medicare WellSelect Plus 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, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Additional preventive services, kidney disease education, and other preventive services require prior authorization, while in-home safety assessments, personal emergency response systems, medical nutrition therapy, re-admission prevention, wigs for hair loss, 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, additional smoking cessation counseling, enhanced disease management, home and bathroom safety devices, counseling services, and telemonitoring services are not covered.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids is unlimited. Prescription hearing aids (all types) have a copay between $699 and $999 per year, and are covered up to 2 visits per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams with a $45 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 include coverage for Medicare Dental Services with a $45 copay, Other Dental Services, 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 and fixed), Maxillofacial Prosthetics, Implant Services, and Oral and Maxillofacial Surgery, all with no copay. Orthodontics is not covered. There is a maximum plan benefit of $1750.00 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Insulin has a $35 copay and a coinsurance between 0-20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the MVP Medicare WellSelect Plus with Part D (PPO) plan. You will pay 20% coinsurance for this service, and prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 0-20% coinsurance, but Durable Medical Equipment for use outside the home and Medical Supplies are not covered. Diabetic Therapeutic Shoes/Inserts are covered with 10% coinsurance, but Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the MVP Medicare WellSelect Plus with Part D (PPO) plan. Diagnostic Procedures/Tests have a copay of $20, while Lab Services are not covered. Diagnostic Radiological Services have a copay between $50 and $250, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the MVP Medicare WellSelect Plus with Part D (PPO) plan, 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 not Additional Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and there is a copay for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MVP Medicare WellSelect Plus with Part D (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The MVP Medicare WellSelect Plus with Part D (PPO) plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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, or Self-Directed Personal Assistance Services. This plan covers Over-the-Counter (OTC) Items with a maximum benefit of $75 every three months. The plan also covers a Meal Benefit for a chronic illness, but requires prior authorization.
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