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MVP Medicare Patriot Plan with Part D (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MVP Medicare Patriot Plan 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 Patriot Plan with Part D (PPO) in 2025, please refer to our full plan details page.
MVP Medicare Patriot Plan 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 Patriot Plan 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 Patriot Plan 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 Patriot Plan with Part D (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $44.00. 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 $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 Patriot Plan with Part D (PPO)
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Drug Coverage
The MVP Medicare Patriot Plan with Part D (PPO) has a $350 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $15 copay for preferred generic drugs at a standard or mail-order pharmacy. For brand-name drugs, you'll pay 26% coinsurance at a standard or mail-order pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The MVP Medicare Patriot Plan with Part D (PPO) offers comprehensive coverage, including inpatient hospital stays with copays, outpatient services with various copays, and coverage for ambulance and emergency services. This plan also includes coverage for primary care, preventive services, hearing and vision services, and dental services, each with specific copays or coinsurance. Additional benefits include home health services, skilled nursing facilities, and coverage for acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $425 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $400 copay for days 1-5, and no copay for days 6-90. Additional days and upgrades for both service types are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a $350 copay, observation services with a $350 copay, ambulatory surgical center (ASC) services with a $250 copay, and outpatient substance abuse services with a $10 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the MVP Medicare Patriot Plan with Part D (PPO), with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $250 copay, and air ambulance services have a $350 copay. Transportation services to a plan-approved health-related location are covered for 12 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the MVP Medicare Patriot Plan with Part D (PPO). Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Transportation has a $250 copay; all services have no coinsurance.
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, but routine care is not covered. Individual and group sessions for mental health and psychiatric services have a $10 copay. Physical Therapy and Speech-Language Pathology Services have a $35 copay.
Preventive Services See details
The MVP Medicare Patriot Plan with Part D (PPO) 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 screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Additional preventive services and kidney disease education services are also covered, but require prior authorization. The 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, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, with no copay or coinsurance, as well as prescription hearing aids with a copay between $699 and $999. 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 $20 copay, and eyewear with 20% coinsurance for contact lenses, with a combined maximum of $225 per year for eyewear. Routine eye exams are covered once per year.
Dental Services See details
Dental Services are covered by the MVP Medicare Patriot Plan with Part D (PPO), with a $30 copay for Medicare Dental Services. Other dental services have a maximum plan benefit coverage of $1,500 per year, with no copay or coinsurance for 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, but orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the MVP Medicare Patriot Plan with Part D (PPO), but prior authorization is required. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the MVP Medicare Patriot Plan with Part D (PPO), with a 20% coinsurance for Durable Medical Equipment. Prosthetic devices have a 0-20% coinsurance, while Durable Medical Equipment for use outside the home and Medical Supplies are not covered. Diabetic Therapeutic Shoes/Inserts have a 10% coinsurance, while Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with some services requiring prior authorization. Diagnostic Procedures/Tests have a copay of $15, and Diagnostic Radiological Services have a copay between $50 and $300, while Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the MVP Medicare Patriot Plan with Part D (PPO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the MVP Medicare Patriot Plan with Part D (PPO), including Additional Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MVP Medicare Patriot Plan with Part D (PPO). There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The MVP Medicare Patriot Plan with Part D (PPO) covers acupuncture with a 50% coinsurance, up to 10 treatments per year. Over-the-counter items are also covered, with a maximum benefit of $50 every three months. Meal benefits are covered for chronic illnesses, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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