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MVP Medicare Complete Wellness with Part D (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MVP Medicare Complete Wellness 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 Complete Wellness with Part D (PPO) in 2025, please refer to our full plan details page.
MVP Medicare Complete Wellness 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 Complete Wellness 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 Complete Wellness 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 Complete Wellness 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 $7.60. 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 $550.00 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 $13500.00 (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 $13500.00 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 MVP Medicare Complete Wellness with Part D (PPO) plan has a $550 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For preferred generic drugs, the copay is $20 at standard and mail-order pharmacies. For standard generic drugs, the copay is $47 at standard and mail-order pharmacies. Preferred brand drugs have a 25% coinsurance, and non-preferred drugs have a 26% coinsurance.
Additional Benefits
The MVP Medicare Complete Wellness with Part D (PPO) plan offers a range of benefits, including inpatient hospital stays with copays that vary by length of stay. Outpatient services are covered with coinsurance, and you'll pay copays for services like primary care, specialist visits, and mental health. This plan also covers preventive services, hearing and vision services, and dental services, with specific copays or coinsurance amounts for each. Additional benefits include ambulance services with copays, and coverage for home health services with no copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits for MVP Medicare Complete Wellness with Part D (PPO) include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a copay of $395 for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a copay of $335 for days 1-6, and no copay for days 7-90. Additional Days and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services and observation services, are covered with a 20% coinsurance. Outpatient substance abuse services are covered with a $10 copay for both individual and group sessions. Ambulatory Surgical Center (ASC) Services are covered with 15% coinsurance. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the MVP Medicare Complete Wellness with Part D (PPO) plan, but requires prior authorization. You will pay a copay of $80 for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MVP Medicare Complete Wellness with Part D (PPO) plan. Ground ambulance services have a $300 copay, and air ambulance services have a $500 copay, with no coinsurance for either. 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 MVP Medicare Complete Wellness with Part D (PPO). Emergency Services and Worldwide Emergency Coverage have a $110 copay, Worldwide Emergency Transportation has a $300 copay, and Urgently Needed Services have a $45 copay.
Primary Care See details
The MVP Medicare Complete Wellness with Part D (PPO) plan covers primary care physician services, occupational therapy services with a $35 copay, physician specialist services with a $55 copay, and physical therapy and speech-language pathology services with a $35 copay. Chiropractic services have a $15 copay, while individual and group sessions for mental health and psychiatric services have a $10 copay. Other health care professionals and opioid treatment program services have copays ranging from $0 to $55 and $10, respectively. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The MVP Medicare Complete Wellness with Part D (PPO) plan covers preventive services, including annual physical exams, health education, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. This plan also covers fitness benefits, remote access technologies and post-discharge in-home medication reconciliation. However, some services such as in-home safety assessments, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered. Prescription hearing aids are covered with a copay between $699 and $999 for all types, 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 includes eye exams with a $50 copay, and eyewear with a 20% coinsurance for contact lenses. This plan also covers eyeglasses, eyeglass lenses, eyeglass frames, and upgrades with no coinsurance or copay. There is a maximum plan benefit of $300 for eye exams, and a combined maximum of $225 for eyewear.
Dental Services See details
Dental Services are covered by the MVP Medicare Complete Wellness with Part D (PPO) plan, with a $40 copay for Medicare Dental Services. Other Dental Services have a maximum plan benefit of $750 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. The plan covers Medicare Part B insulin drugs with a $35 copay and 0-20% coinsurance, and other Medicare Part B drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a coinsurance for Medicare-covered medical supplies, Prosthetic Devices with a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with a 10% coinsurance. Durable 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. There is no copay for diagnostic services, and Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services all have a coinsurance of at most 20%. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the MVP Medicare Complete Wellness 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 Complete Wellness with Part D (PPO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization, with 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
Other Services include acupuncture, which has a 50% coinsurance up to 12 treatments per year, and over-the-counter items, which are covered up to $50 every three months. Meal Benefit, 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, and Self-Directed Personal Assistance Services are not covered.
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