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UVM Health Advantage Select (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UVM Health Advantage Select (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UVM Health Advantage Select (PPO) in 2025, please refer to our full plan details page.
UVM Health Advantage Select (PPO) is a PPO plan offered by MVP Health Care, Inc. available for enrollment in 2025 to people living in Northern NY. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that UVM Health Advantage Select (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 UVM Health Advantage Select (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 UVM Health Advantage Select (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 $9.80. 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 $9000.00 (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 $9000.00 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:
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Drug Coverage
The UVM Health Advantage Select (PPO) plan has a $350 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, in the initial coverage phase, you may pay a $10 copay for preferred generic drugs at a standard or mail-order pharmacy. For preferred brand drugs, you pay 25% coinsurance. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The UVM Health Advantage Select (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay for the first few days, and outpatient services with a copay. This plan also covers emergency services, primary care, preventive services, and home health services. Additional benefits include coverage for hearing, vision, and dental services, with copays or coinsurance depending on the specific service. The plan also covers ambulance services, medical equipment, and diagnostic services, while also offering additional services such as acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $375 copay for days 1-3, and no copay for days 4-90, with an out-of-pocket maximum of $1,125; additional days are covered with no copay. For Inpatient Hospital Psychiatric, there is a $375 copay for days 1-3, and no copay for days 4-90, with an out-of-pocket maximum of $1,125; additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, have a copay of $325.00. Ambulatory Surgical Center (ASC) Services have a copay of $225.00. Outpatient Substance Abuse Services have a copay of $20.00 for individual sessions and $10.00 for group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the UVM Health Advantage Select (PPO) plan. This benefit has a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $300 copay for both ground and air ambulance services. Transportation services to plan-approved health-related locations are covered for up to 12 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the UVM Health Advantage Select (PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $40 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
The UVM Health Advantage Select (PPO) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy services with a $30 copay, and physician specialist services with a $35 copay. The plan also covers mental health specialty services with $20 copay for individual sessions and a $10 copay for group sessions, as well as physical therapy and speech-language pathology services with a $30 copay. Additionally, the plan covers other health care professional services with a copay between $0 and $35, psychiatric services with a $20 copay for individual sessions and a $10 copay for group sessions, additional telehealth benefits, and opioid treatment program services. Podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other services, are covered. Some additional preventive services are not covered, including In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, 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, and Counseling Services.
Hearing Services See details
Hearing services are covered, including routine hearing exams and fitting/evaluation for hearing aids. Routine hearing exams are limited to one per year, and fitting/evaluation for hearing aids has no limit. Prescription hearing aids are covered with a copay between $699 and $999, and are limited to two per year, but inner ear, outer ear, and over-the-ear prescription hearing aids, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision Services include coverage for routine eye exams, eyewear, and upgrades. Eyewear has a 20% coinsurance for contact lenses, while routine eye exams are limited to one per year with a maximum plan benefit of $300 for both in-network and out-of-network services.
Dental Services See details
UVM Health Advantage Select (PPO) covers dental services including oral exams for a $40 copay, and other diagnostic dental services, with a maximum plan benefit of $1500 per year. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UVM Health Advantage Select (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the UVM Health Advantage Select (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit has a coinsurance for Medicare-covered medical supplies, and Prosthetic Devices have between 0% and 20% coinsurance. Diabetic equipment is covered, but Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 10% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a $35 copay, and Diagnostic Radiological Services with a copay of at most $200. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $35 copay; however, Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the UVM Health Advantage Select (PPO) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the UVM Health Advantage Select (PPO) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by UVM Health Advantage Select (PPO), but require prior authorization. For days 1-20 and 56-100, there is no copay, and for days 21-55, there is a $214 copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The UVM Health Advantage Select (PPO) plan covers acupuncture with a 50% coinsurance, and over-the-counter items up to $50 every three months. Meal benefits are covered, but require prior authorization. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are not covered.
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