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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 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
MVP Medicare WellSelect with Part D (PPO) is a PPO plan offered by Mvp Health Plan, Inc. available for the 2026 plan year to people living in Western NY (Rochester/Buffalo). This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $160.00. 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 $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $13900.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for 1-month or 3-month supplies at standard pharmacies and through standard mail order. Tier 2 generic drugs cost a low $2 copay for a 1-month supply at standard pharmacies and mail order, while a 3-month supply is $6 at a standard pharmacy and $4 through standard mail order. Brand-name and specialty medications transition to coinsurance costs under this plan. Tier 3 preferred brand drugs require a 16% coinsurance for both 1-month and 3-month supplies at standard pharmacies and standard mail order. Tier 4 non-preferred drugs and Tier 5 specialty drugs both incur a 25% coinsurance for a 1-month supply.
Additional Benefits
The MVP Medicare WellSelect with Part D (PPO) plan offers robust coverage for everyday healthcare needs, featuring no copays or coinsurance for primary care visits, telehealth, and preventive services. Specialist visits require a $55 copay, while emergency room visits carry a $115 copay and urgent care is $40. For inpatient hospital stays, members pay a daily copay of $445 for the first five days of an acute stay with no coinsurance required. This plan also provides valuable supplemental benefits, including preventive and comprehensive dental care with no copay up to a $750 annual limit. Routine hearing exams have no copay, and routine eye exams are covered with a $20 copay, alongside a $150 annual allowance for eyewear with 20% coinsurance. Additionally, members can access over-the-counter health items with no copay up to a maximum benefit of $25 every three months.
Inpatient Hospital See details
Inpatient hospital care is partially covered by MVP Medicare WellSelect with Part D (PPO) with no coinsurance, requiring a daily copay of $445 for days 1 to 5 of an acute stay (no copay thereafter) and a daily copay of $415 for days 1 to 5 of a psychiatric stay (no copay for days 6 to 90). Upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered, and prior authorization is required.
Outpatient Services See details
MVP Medicare WellSelect with Part D (PPO) covers outpatient services with no copay for hospital, ambulatory surgical center (ASC), and blood services, though a 20% coinsurance applies to hospital and observation services and a 15% coinsurance applies to ASC services. Outpatient substance abuse services require a $10 copay with no coinsurance, while blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization services are covered under MVP Medicare WellSelect with Part D (PPO) with no copay and a 30% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
MVP Medicare WellSelect with Part D (PPO) partially covers ambulance and transportation services, featuring a $320 copay for ground ambulance and a $500 copay for air ambulance with no coinsurance required for either service. Prior authorization is required for ambulance services, copays are not waived upon hospital admission, and transportation services to health-related locations are not covered.
Emergency Services See details
MVP Medicare WellSelect with Part D (PPO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and urgently needed care with a $40 copay, with no coinsurance or deductibles required for either. Worldwide emergency and urgent services are covered with a $115 copay, while worldwide emergency transportation requires a $320 copay, all with no coinsurance.
Primary Care See details
MVP Medicare WellSelect with Part D (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $55 copay and no coinsurance. Physical, occupational, and speech therapies have a $35 copay, and mental health, psychiatric, and opioid treatment services require a $10 copay, all with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by MVP Medicare WellSelect with Part D (PPO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive services are partially covered, though sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and alternative therapies are not covered.
Hearing Services See details
Hearing services are partially covered by MVP Medicare WellSelect with Part D (PPO), which offers routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered for up to two devices per year with no coinsurance and a copay ranging from $699 to $999, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
MVP Medicare WellSelect with Part D (PPO) offers partially covered vision services with no deductibles, featuring one routine eye exam per year for a $20 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and a 20% coinsurance for contact lenses, up to a combined maximum plan benefit of $150 annually for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
MVP Medicare WellSelect with Part D (PPO) covers Medicare-covered dental services with a $50 copay and no coinsurance, and other preventive and comprehensive dental services with no copay or coinsurance up to a $750 annual maximum. Dental benefits are partially covered, as orthodontics is not covered under this plan.
Home Infusion bundled Services See details
MVP Medicare WellSelect with Part D (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Associated Medicare Part B drugs, including insulin, chemotherapy, and other drugs, carry a copay of up to $35 and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
MVP Medicare WellSelect with Part D (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Medical equipment is partially covered by MVP Medicare WellSelect with Part D (PPO), as medical supplies are not covered. Covered durable medical equipment (DME) requires no copay and 20% coinsurance, prosthetic devices have no copay and no coinsurance to 20% coinsurance, and diabetic services require a $10 copay with no coinsurance for supplies or 20% coinsurance with no copay for shoes and inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services under MVP Medicare WellSelect with Part D (PPO) are partially covered, as lab services are not covered. Covered diagnostic procedures require no copay and 20% coinsurance, while radiological services require prior authorization and carry a $55 copay for outpatient X-rays and diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by MVP Medicare WellSelect with Part D (PPO) with no copay and no coinsurance. Prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the MVP Medicare WellSelect with Part D (PPO) plan with no copay and require prior authorization. While some services are covered, specific treatments including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and carry a 25% coinsurance.
Skilled Nursing Facility (SNF) See details
MVP Medicare WellSelect with Part D (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
MVP Medicare WellSelect with Part D (PPO) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $25 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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