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Trinity Health Plan New York Cash Back (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Trinity Health Plan New York Cash Back (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 Cash Back (HMO) in 2025, please refer to our full plan details page.
Trinity Health Plan New York Cash Back (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 Cash Back (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 Cash Back (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 Cash Back (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 $71.90. 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 $350.00 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 $7300.00 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 Cash Back (HMO) plan has a $350 deductible for prescription drugs. After the deductible, you will pay varying costs depending on the drug tier and pharmacy type. For example, for preferred generic drugs at a standard pharmacy, you pay a $5 copay, while preferred mail order has no copay. For standard generic drugs, you pay 25% coinsurance at both preferred and standard mail order pharmacies. For preferred brand drugs, you pay 50% coinsurance at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Trinity Health Plan New York Cash Back (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays between $0 and $395. Emergency and urgent care services have copays, and primary care visits have no copay, while specialist visits have a $45 copay. Preventive services and many vision and dental services have no copay, and hearing aids have a copay. The plan also covers home health services with no copay, and skilled nursing facility stays have copays depending on the length of stay. Other benefits include ambulance services, diagnostic services, and a meal benefit, all with differing costs.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered. For acute care, you will pay a $395 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. Inpatient psychiatric care has the same cost-sharing structure. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $395, Observation Services with no copay, Ambulatory Surgical Center (ASC) Services with a $395 copay, and both Individual and Group Sessions for Outpatient Substance Abuse with a $40 copay. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $50 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Trinity Health Plan New York Cash Back (HMO) plan. Medicare-covered ground ambulance services have a $300 copay, and air ambulance services have a $350 copay, with no coinsurance for either service. 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 Cash Back (HMO). Emergency Services and Worldwide Emergency Coverage have a $110 copay, and Urgently Needed Services have a $40 copay. Worldwide Emergency Transportation has a copay between $300 and $350. All services have no coinsurance.
Primary Care See details
Under the Trinity Health Plan New York Cash Back (HMO) plan, Primary Care Physician Services have no copay, Chiropractic Services have a $15 copay, and Occupational Therapy Services have a $35 copay. Physician Specialist Services have a $45 copay, and Physical Therapy and Speech-Language Pathology Services have a $35 copay. Mental Health and Psychiatric Services have a $40 copay for individual and group sessions. Other Health Care Professional services have a copay between $0 and $45, and Additional Telehealth Benefits have a copay between $0 and $45. Opioid Treatment Program Services have a $40 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered and additional preventive services. The annual physical exam has no copay, while other preventive services, such as Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $45 copay, routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids have a copay between $599 and $899. OTC hearing aids are not covered.
Vision Services See details
The Trinity Health Plan New York Cash Back (HMO) plan covers vision services, including eye exams with a copay between $0 and $45, and eyewear with no copay and a combined maximum benefit of $150 per year. Routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses are covered with no copay, but upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $45 copay, oral exams and dental x-rays with no copay, and other diagnostic dental services, prophylaxis (cleaning), and fluoride treatment with no copay. Restorative services and oral and maxillofacial surgery are covered with 50% coinsurance, while endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan also has a $1,000 maximum plan benefit coverage per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have 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 under the Trinity Health Plan New York Cash Back (HMO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a $40 copay, lab services with no copay, and all radiological services. Diagnostic Radiological Services have a copay of at most $275, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Trinity Health Plan New York Cash Back (HMO) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Trinity Health Plan New York Cash Back (HMO), but the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. There is a copay for some of these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Trinity Health Plan New York Cash Back (HMO) 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
The Trinity Health Plan New York Cash Back (HMO) plan covers acupuncture with a $20 copay and over-the-counter items with no copay. The plan also covers a meal benefit with no copay, but does not cover dual eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, or many other services.
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