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Trinity Health Plan New York No Premium (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Trinity Health Plan New York No Premium (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Trinity Health Plan New York No Premium (HMO) in 2025, please refer to our full plan details page.
Trinity Health Plan New York No Premium (HMO) is a HMO plan offered by Trinity Health Corporation available for enrollment in 2025 to people living in Select Counties in New York. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Trinity Health Plan New York No Premium (HMO) 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 Trinity Health Plan New York No Premium (HMO).
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 Trinity Health Plan New York No Premium (HMO), 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 $14.70. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6200.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network 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:
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Drug Coverage
The Trinity Health Plan New York No Premium (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy type. For example, you'll pay a $5 copay at a standard pharmacy for Tier 1 drugs, or 25% coinsurance for Tier 2 drugs purchased through the standard or mail order pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. This plan may offer a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The Trinity Health Plan New York No Premium (HMO) offers a range of benefits with varying costs. Hospital stays have a $300 copay for the first five days, and no copay for days 6-90. Outpatient services and primary care visits often have copays, while preventive services, vision, and dental services have some services with no copay. This plan also covers ambulance services, emergency services, and home health services, each with its own copay structure. Additional benefits include hearing exams, eyewear, and some dental services.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a $300 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay 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 includes coverage for Outpatient Hospital Services with a copay between $0 and $295, Observation Services with no copay, Ambulatory Surgical Center (ASC) Services with a $295 copay, Individual and Group Sessions for Outpatient Substance Abuse with a copay of $30, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Trinity Health Plan New York No Premium (HMO) with a $50 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Trinity Health Plan New York No Premium (HMO) plan. Medicare-covered ground ambulance services have a $240 copay, and air ambulance services have a $290 copay, with no coinsurance. 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 the Trinity Health Plan New York No Premium (HMO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $30 copay, but both have no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a copay of $110, and Worldwide Emergency Transportation has a copay of $240-$290, but all have no coinsurance.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $20 copay. Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services all have a $30 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a copay of $30 for individual and group sessions. Additional Telehealth Benefits have a copay between $0 and $30.
Preventive Services See details
Preventive services include annual physical exams with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered, and some services have a $0 copay. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, 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 of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, or telemonitoring services.
Hearing Services See details
The Trinity Health Plan New York No Premium (HMO) plan covers hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $599 and $899 for all types of prescription hearing aids, but inner ear, outer ear, and over the ear prescription hearing aids are not covered; OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$30, and eyewear with no copay. Eyewear has a combined maximum benefit of $200 per year, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $30 copay for Medicare Dental Services, and no copay for Other Dental Services. Restorative Services and Oral and Maxillofacial Surgery have a 50% coinsurance, while Endodontics and Periodontics have a 70% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Trinity Health Plan New York No Premium (HMO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Trinity Health Plan New York No Premium (HMO). You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment includes coverage for Durable Medical Equipment (DME) with a 20% coinsurance and no copay, and for Prosthetic Devices and Medical Supplies with a 20% coinsurance and no copay. Diabetic equipment is covered, and includes a 20% coinsurance for Medicare-covered Diabetic Supplies and a 20% coinsurance for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, lab services with no copay, and outpatient X-ray services with no copay. Diagnostic Procedures/Tests have a $30 copay, and Diagnostic Radiological Services have a copay of at least $170. Therapeutic Radiological Services have at least 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Trinity Health Plan New York No Premium (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Trinity Health Plan New York No Premium (HMO). The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under this plan. There is no copay for days 1-20 and days 56-100, but there is a $214 copay for days 21-55.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $20 copay, and OTC items have no copay. The meal benefit also has no copay. However, several other services are not covered.
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