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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 2026, 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 2026 to people living in Northern NY. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $174.00. 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. 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 $13900.00 (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 $13900.00 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 Complete Wellness with Part D (PPO)
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Drug Coverage
The MVP Medicare Complete Wellness with Part D (PPO) plan features an annual prescription drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for one-month and three-month supplies at standard pharmacies and standard mail order. Tier 2 generic drugs require a low $2.00 copay for a one-month supply, with three-month supplies costing $6.00 at standard pharmacies and $4.00 through standard mail order. For higher-tier medications, cost sharing transitions to coinsurance. Tier 3 preferred brand drugs require a 16% coinsurance for both standard pharmacy and standard mail order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance for a one-month supply.
Additional Benefits
The MVP Medicare Complete Wellness with Part D (PPO) plan offers comprehensive medical coverage, including primary care, telehealth, and preventive services with no copay and no coinsurance. Specialist visits require a $55 copay, while inpatient acute hospital stays incur a $445 copay for the first five days with no copay for days six through 90. Outpatient hospital and ambulatory surgical services are covered with no copay and a 15% to 20% coinsurance. For routine wellness, the plan features dental and hearing services with no copays, including up to a $750 annual limit for dental care. Routine eye exams are available for a $20 copay, and home health services are fully covered with no copay or coinsurance. Additionally, members receive a $25 quarterly allowance for over-the-counter health items with no copay.
Inpatient Hospital See details
MVP Medicare Complete Wellness with Part D (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $445 copayment for days 1-5 of acute stays and a $415 copayment for days 1-5 of psychiatric stays, with no copayments for days 6-90. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
MVP Medicare Complete Wellness with Part D (PPO) covers outpatient hospital and observation services with a 20% coinsurance and no copay, and ambulatory surgical center services with a 15% coinsurance and no copay. Outpatient substance abuse services require a $10 copay per session with no coinsurance, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the MVP Medicare Complete Wellness with Part D (PPO) plan with no copay and a 30% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
MVP Medicare Complete Wellness with Part D (PPO) covers ground ambulance services with a $320 copay and air ambulance services with a $500 copay, with no coinsurance required for either service. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
MVP Medicare Complete Wellness with Part D (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency and urgent care carry a $115 copay (and $320 for worldwide emergency transportation) with no coinsurance.
Primary Care See details
MVP Medicare Complete Wellness with Part D (PPO) covers primary care and telehealth services with no copay and no coinsurance. Specialist visits require a $55 copay, therapy services cost a $35 copay, and mental health or psychiatric sessions cost a $10 copay, all with no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by MVP Medicare Complete Wellness with Part D (PPO) with no copay and no coinsurance, although prior authorization is required for certain benefits. While annual physicals, kidney disease education, and diabetes self-management are covered, sub-services such as in-home safety assessments, medical nutrition therapy, weight management, and therapeutic massage are not covered.
Hearing Services See details
Hearing services are partially covered by MVP Medicare Complete Wellness with Part D (PPO), offering one annual routine exam and unlimited fitting evaluations with no deductible, no copay, and no coinsurance. While up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $699 to $999, OTC hearing aids as well as inner ear, outer ear, and over the ear prescription devices are not covered.
Vision Services See details
Vision services are partially covered by MVP Medicare Complete Wellness with Part D (PPO), offering one routine eye exam annually for a $20 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and a 20% coinsurance up to a $150 annual limit, and no deductibles apply to these benefits.
Dental Services See details
MVP Medicare Complete Wellness with Part D (PPO) provides partially covered dental services, featuring Medicare-covered dental services for a $50 copay and no coinsurance, alongside other dental services with no copay and no coinsurance up to a $750 annual limit. While most preventive and restorative services are covered, orthodontics is not covered by this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by MVP Medicare Complete Wellness with Part D (PPO) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance to 20%, while covered insulin has a $35 copay and a coinsurance of up to 20%.
Dialysis Services See details
Dialysis services are covered by MVP Medicare Complete Wellness with Part D (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
MVP Medicare Complete Wellness with Part D (PPO) partially covers medical equipment, as medical supplies are not covered. Durable medical equipment requires no copay and a 20% coinsurance, while prosthetic devices have no copay and range from no coinsurance to 20% coinsurance. Diabetic supplies cost a $10 copay with no coinsurance, and diabetic shoes or inserts require no copay and a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by MVP Medicare Complete Wellness with Part D (PPO), with lab services being not covered. Covered diagnostic procedures and therapeutic radiological services require a 20% coinsurance and no copay, while outpatient x-rays and diagnostic radiological services incur a $55 copay and no coinsurance.
Home Health Services See details
Home Health Services are covered by MVP Medicare Complete Wellness with Part D (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the MVP Medicare Complete Wellness with Part D (PPO) plan with no copay and no coinsurance, subject to prior authorization. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and carry a 25% coinsurance.
Skilled Nursing Facility (SNF) See details
MVP Medicare Complete Wellness with Part D (PPO) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
MVP Medicare Complete Wellness with Part D (PPO) provides partial coverage for other services, which includes up to $25 every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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