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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 2026, 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 2026.
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 $7.00. 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 $125.00 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 Maximum Out-Of-Pocket cost of $6750.00 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) features an annual drug deductible of $125. Under this plan, Tier 1 preferred generic drugs are available with no copay for both standard pharmacy and standard mail order options. Tier 2 generic drugs also feature no copay through standard mail order, or low standard pharmacy copays starting at $5 for a one-month supply. Higher-tier medications require coinsurance rather than set copays for both standard pharmacy and standard mail order purchases. Members pay 25% coinsurance for Tier 3 preferred brand drugs and 45% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs carry a 31% coinsurance for a one-month supply.
Additional Benefits
The Trinity Health Plan New York No Premium (HMO) offers robust healthcare coverage featuring no copay for primary care doctor visits, preventive care services, and home health visits. For inpatient hospital stays, members pay a $350 daily copay for days 1 through 5 and no copay for days 6 through 90, with no coinsurance required. Outpatient hospital services and specialist visits are also affordable, with no coinsurance and copays ranging from no copay up to $30 for specialists. Additional benefits include dental, vision, and hearing coverage, highlighted by no copay for routine eye exams and preventive dental care up to a $1,000 annual limit. Prescription hearing aids are covered with copays between $599 and $899, while medical equipment and dialysis services require no copay and a 20% coinsurance. Members also benefit from a quarterly over-the-counter item allowance of $75 with no copay or coinsurance.
Inpatient Hospital See details
Trinity Health Plan New York No Premium (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Trinity Health Plan New York No Premium (HMO) with no coinsurance, featuring outpatient hospital copays ranging from no copay to $350 and observation services at a $340 copay per stay. Ambulatory surgical center services require a $350 copay with no coinsurance, outpatient substance abuse sessions require a $30 copay with no coinsurance, and outpatient blood services are covered with no copay, no deductible, and no coinsurance.
Partial Hospitalization See details
Trinity Health Plan New York No Premium (HMO) covers partial hospitalization services with a $60.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance services are covered by Trinity Health Plan New York No Premium (HMO) with no coinsurance, requiring a $240 copay for ground transport and a $290 copay for air transport, both of which require prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Trinity Health Plan New York No Premium (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $130 to $290.
Primary Care See details
Trinity Health Plan New York No Premium (HMO) provides primary care physician visits and telehealth benefits with no copay and no coinsurance. Specialist visits, therapy, and mental health services require a $30 copay and no coinsurance, while podiatry and routine chiropractic care are not covered.
Preventive Services See details
Trinity Health Plan New York No Premium (HMO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. However, additional preventive services are only partially covered, with excluded sub-services including health education, weight management, nutritional benefits, in-home support, and personal emergency response systems.
Hearing Services See details
Trinity Health Plan New York No Premium (HMO) partially covers hearing services, featuring a $30 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with a copay of $599 to $899 and no coinsurance for up to two aids yearly, while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Trinity Health Plan New York No Premium (HMO) provides partially covered vision services with no coinsurance, featuring no copay for one annual routine eye exam and covered eyewear up to a $200 yearly limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Trinity Health Plan New York No Premium (HMO), featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care up to a $1,000 annual limit. Comprehensive dental services require no copay with coinsurance between 0% and 70%, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Trinity Health Plan New York No Premium (HMO) with no copay, although prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Trinity Health Plan New York No Premium (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Trinity Health Plan New York No Premium (HMO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay under manufacturer limitations, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Trinity Health Plan New York No Premium (HMO) covers diagnostic and radiological services, offering lab services with no copay or coinsurance and diagnostic tests with a $30 copay and no coinsurance. Outpatient X-rays require a $10 copay and coinsurance, while diagnostic radiological services have a copay starting at $195 with no coinsurance, and therapeutic radiological services carry a 20% coinsurance along with a copay.
Home Health Services See details
Home health services are covered by the Trinity Health Plan New York No Premium (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under the Trinity Health Plan New York No Premium (HMO), but only some services are covered as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require copayments of $15 to $30.
Skilled Nursing Facility (SNF) See details
Trinity Health Plan New York No Premium (HMO) covers skilled nursing facility (SNF) care with no coinsurance, offering no copay for days 1 through 20 and days 61 through 100, and a $218 daily copay for days 21 through 60. A prior three-day inpatient hospital stay is not required for admission, though additional coverage beyond the standard 100-day Medicare benefit is not covered.
Other Services See details
Trinity Health Plan New York No Premium (HMO) covers acupuncture with a $20 copay and no coinsurance for up to six treatments per year, subject to prior authorization. Over-the-counter items up to $75 every three months and meal benefits for chronic illness are also covered with no copay and no coinsurance.
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