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Trinity Health Plan New York Glory No RX (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Trinity Health Plan New York Glory No RX (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 Glory No RX (HMO) in 2026, please refer to our full plan details page.
Trinity Health Plan New York Glory No RX (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 Glory No RX (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Trinity Health Plan New York Glory No RX (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 Glory No RX (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 $60.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5500.00 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
Prescription drugs are not covered by Trinity Health Plan New York Glory No RX (HMO).
Additional Benefits
Trinity Health Plan New York Glory No RX (HMO) features affordable healthcare coverage with no copay and no coinsurance for primary care visits, routine vision exams, and home health services. Specialist visits, diagnostic procedures, and Medicare-covered dental exams require a low $25 copay with no coinsurance. For more intensive care, inpatient hospital stays require a $375 daily copay for the first five days followed by no copay, while emergency room visits carry a $130 copay. The plan also provides generous ancillary benefits, including a $1,000 annual limit for preventive dental care and a $200 annual limit for eyewear with no copay. Routine hearing exams are available with no copay, while prescription hearing aids require copays ranging from $399 to $699. Additionally, durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance, and members receive a $50 quarterly over-the-counter allowance with no copay.
Inpatient Hospital See details
Trinity Health Plan New York Glory No RX (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $375 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 psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by the Trinity Health Plan New York Glory No RX (HMO) feature no coinsurance, with outpatient hospital copays ranging from no copay to $350 and observation services requiring a $365 copay per stay. Ambulatory surgical center services carry a $350 copay, outpatient substance abuse sessions have a $25 copay, and outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Trinity Health Plan New York Glory No RX (HMO) covers partial hospitalization services with a $50.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Trinity Health Plan New York Glory No RX (HMO), which features a $150 copay for ground ambulance and a $200 copay for air ambulance with no coinsurance required for either service. Prior authorization is required for ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
Trinity Health Plan New York Glory No RX (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 and no coinsurance, while worldwide emergency and urgent care have a $130 copay and worldwide transportation copays range from $150 to $200, all with no coinsurance.
Primary Care See details
Trinity Health Plan New York Glory No RX (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits, therapies, and mental health sessions require a $25 copay and no coinsurance. Telehealth and other healthcare professional services range from no copay to a $25 copay with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Trinity Health Plan New York Glory No RX (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, diabetes training, and fitness benefits. However, the benefit is only partially covered, as it excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Trinity Health Plan New York Glory No RX (HMO) covers hearing services with no deductibles, offering Medicare-covered exams for a $25 copay and routine exams or fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays between $399 and $699, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Trinity Health Plan New York Glory No RX (HMO), featuring no deductibles and no coinsurance. Routine eye exams (one per year) and eyewear have no copay, with a $200 annual limit for eyewear, though other eye exams have a copay of up to $25, and other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by the Trinity Health Plan New York Glory No RX (HMO), as maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare-covered dental services require a $25 copay and no coinsurance, preventive care has no copay and no coinsurance up to a $1,000 annual limit, and covered comprehensive services have no copay and 0% to 70% coinsurance.
Home Infusion bundled Services See details
Trinity Health Plan New York Glory No RX (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Trinity Health Plan New York Glory No RX (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Trinity Health Plan New York Glory No RX (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Covered diabetic supplies have no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Trinity Health Plan New York Glory No RX (HMO) covers diagnostic and radiological services with no coinsurance for diagnostic services, which feature no copay for lab services and a $25 copay for diagnostic procedures. Radiological services require a $35 copay for outpatient X-rays, a $275 copay for diagnostic radiological services, and 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by Trinity Health Plan New York Glory No RX (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no coinsurance under the Trinity Health Plan New York Glory No RX (HMO), though 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 require copayments ranging from $15 to $25.
Skilled Nursing Facility (SNF) See details
Trinity Health Plan New York Glory No RX (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day inpatient hospital stay requirement. Patients pay no copay for days 1 to 20 and days 61 to 100, but a $218 daily copay applies for days 21 to 60, with additional days beyond the 100-day limit not covered.
Other Services See details
Other services covered by Trinity Health Plan New York Glory No RX (HMO) include acupuncture with a $20 copay and no coinsurance, limited to 12 treatments per year with prior authorization. Additionally, the plan offers chronic illness meals and a $50 quarterly over-the-counter allowance, both with no copay and no coinsurance.
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