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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 Southern Tier NY, Central NY, Eastern 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 $15.00. 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 has an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a one-month or three-month supply filled at standard pharmacies or through standard mail order. Tier 2 generic drugs require a $2.00 copay for a one-month supply, while a three-month supply costs $6.00 at standard pharmacies and $4.00 through standard mail order. For higher-tier medications, cost sharing is based on coinsurance rather than flat copayments. Tier 3 preferred brand drugs carry a 16% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance rates apply to both standard pharmacy and standard mail order options.
Additional Benefits
The MVP Medicare Complete Wellness with Part D (PPO) plan offers comprehensive coverage with many essential services requiring no copayments or coinsurance. Members enjoy no copay for primary care physician visits, telehealth, home health services, and routine preventive care. Inpatient hospital stays require a daily copay for the first five days ($445 for acute and $415 for psychiatric), followed by no copay for unlimited additional days. Other medical services are subject to flat copays or coinsurance. Emergency room visits require a $115 copay, specialists require a $55 copay, and ground ambulance services carry a $320 copay. Outpatient hospital care, dialysis, and durable medical equipment generally require a 15% to 20% coinsurance with no copay, while routine dental and hearing exams are available with no copay.
Inpatient Hospital See details
MVP Medicare Complete Wellness with Part D (PPO) partially covers inpatient hospital stays with no coinsurance, requiring a daily copay of $445 for days 1-5 of acute stays and $415 for days 1-5 of psychiatric stays, followed by no copay. Unlimited additional acute days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
MVP Medicare Complete Wellness with Part D (PPO) covers outpatient services, featuring no copay and a 20% coinsurance for outpatient hospital and observation services, and no copay with a 15% coinsurance for ambulatory surgical center services. Outpatient substance abuse sessions require a $10 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
MVP Medicare Complete Wellness with Part D (PPO) covers partial hospitalization services with no copay and a 30% coinsurance. Prior authorization is required for these covered 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 health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by MVP Medicare Complete Wellness with Part D (PPO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay, while worldwide emergency and urgent services have a $115 copay ($320 for worldwide emergency transportation), all with no coinsurance and no deductible.
Primary Care See details
Primary care benefits under the MVP Medicare Complete Wellness with Part D (PPO) plan feature no copay and no coinsurance for primary care physician visits and telehealth services. Specialist visits require a $55 copay, physical, occupational, and speech therapy services require a $35 copay, and mental health, psychiatric, and opioid treatment services require a $10 copay, all with no coinsurance. Chiropractic and podiatry services are not covered.
Preventive Services See details
MVP Medicare Complete Wellness with Part D (PPO) offers preventive services with no copay and no coinsurance, including annual physical exams and kidney disease education. These benefits are partially covered, as the plan excludes sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
MVP Medicare Complete Wellness with Part D (PPO) provides hearing services with no copay or coinsurance for one routine hearing exam per year and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $699.00 to $999.00 for up to two aids yearly, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by MVP Medicare Complete Wellness with Part D (PPO), which features a $20 copay and no coinsurance for one routine annual eye exam up to a $70 limit, while other eye exam services are not covered. Eyewear is covered with no copay and a 20% coinsurance for contact lenses, up to a $150 combined annual limit that covers contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
MVP Medicare Complete Wellness with Part D (PPO) offers partially covered dental services, featuring no copay and no coinsurance for most preventive and comprehensive dental care up to a combined annual maximum of $750. Medicare-covered dental services require a $50 copay and no coinsurance, while orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by MVP Medicare Complete Wellness with Part D (PPO) with no copay, although prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy and insulin, have a 0% to 20% coinsurance and copays ranging from $0 to $35.
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 covered 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 (DME) is covered with no copay and 20% coinsurance, prosthetic devices feature no copay and no coinsurance to 20% coinsurance, and diabetic equipment is covered with a $10 copay for supplies and 20% coinsurance for therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by MVP Medicare Complete Wellness with Part D (PPO) since lab services are not covered and prior authorization is required. Diagnostic procedures and tests require no copay and a 20% minimum coinsurance, while diagnostic radiological services carry a $55.00 minimum copay and no coinsurance. Outpatient x-rays require a $55.00 copay and coinsurance, while therapeutic radiological services require a copay and a 20% minimum coinsurance.
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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by MVP Medicare Complete Wellness with Part D (PPO) with no copay and prior authorization required, but only some services are covered. Standard 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
Skilled nursing facility (SNF) care is covered by MVP Medicare Complete Wellness with Part D (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a daily copay of $218 for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by MVP Medicare Complete Wellness with Part D (PPO), providing over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $25 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone coverage are not covered.
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