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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 2026, 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 2026.
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 $70.00. 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 $275.00 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 $8500.00 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) features an annual drug deductible of $275. For Tier 1 preferred generic drugs, members pay no copay at standard pharmacies and standard mail order for up to a 3-month supply. Tier 2 generic drugs are also available with no copay through standard mail order, while standard pharmacy purchases require a copay of $5 for a 1-month, $10 for a 2-month, or $15 for a 3-month supply. Brand-name and specialty medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require 25% coinsurance, and Tier 4 non-preferred drugs carry a 35% coinsurance, applicable to both standard pharmacies and standard mail order. Tier 5 specialty drugs require a 29% coinsurance for a 1-month supply at standard pharmacies and standard mail order.
Additional Benefits
The Trinity Health Plan New York Cash Back (HMO) offers comprehensive coverage with no copay for primary care visits, home health services, and routine preventive care. For other medical needs, members will pay predictable copays, including $45 for specialist visits, $115 for emergency care, and a daily copay for the first five days of inpatient hospital stays. Diagnostic lab work is also covered with no copay, while outpatient hospital services and complex imaging require copayments. Supplemental benefits include routine dental, vision, and hearing exams with no copay, alongside allowances for eyewear and preventive dental services up to plan maximums. For specialized medical supplies and treatments, members are responsible for a twenty percent coinsurance on durable medical equipment, dialysis, and therapeutic radiology. Prescription hearing aids and restorative dental care are also partially covered with applicable copays or coinsurance.
Inpatient Hospital See details
Trinity Health Plan New York Cash Back (HMO) covers inpatient hospital services with no coinsurance, although prior authorization is required. For acute stays, there is a $425 daily copay for days 1 through 5 and no copay for additional days, while psychiatric stays require a $415 daily copay for days 1 through 5 and no copay for days 6 through 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Trinity Health Plan New York Cash Back (HMO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $425 for outpatient hospital services and a $425 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by the Trinity Health Plan New York Cash Back (HMO) with a $60.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services under the Trinity Health Plan New York Cash Back (HMO) require prior authorization, featuring a $300 copay for ground ambulance and a $350 copay for air ambulance with no coinsurance. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Trinity Health Plan New York Cash Back (HMO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 48 hours, and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent services are covered with a $115 copay, while worldwide emergency transportation has a copay of $300 to $350, all with no coinsurance.
Primary Care See details
Primary care benefits under the Trinity Health Plan New York Cash Back (HMO) feature no copay and no coinsurance for primary care doctor visits, while specialist visits require a $45 copay and no coinsurance. Physical, occupational, and speech therapies have a $35 copay and no coinsurance, mental health services require a $40 copay and no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Trinity Health Plan New York Cash Back (HMO) provides preventive services with no copay and no coinsurance, including annual physicals, kidney disease education, and select fitness and remote access benefits. Additional preventive services are only partially covered, as the plan does not cover 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, additional smoking cessation, disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Trinity Health Plan New York Cash Back (HMO) covers Medicare-covered hearing exams with a $45 copay and no coinsurance, and routine exams or fittings with no copay and no coinsurance. Hearing aids are partially covered with a $599 to $899 copay and no coinsurance for up to two prescription aids per year, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Trinity Health Plan New York Cash Back (HMO) partially covers vision services with no coinsurance, offering one routine eye exam per year and covered eyewear with no copay. Eyewear is subject to a combined $150 annual maximum, though upgrades and other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Trinity Health Plan New York Cash Back (HMO), featuring a $1,000 annual maximum with no copay and no coinsurance for exams, cleanings, fluoride, and x-rays. Medicare-covered dental requires a $45 copay and no coinsurance, while restorative services and oral surgery have no copay and 50% coinsurance. Other preventive services, endodontics, periodontics, prosthodontics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Trinity Health Plan New York Cash Back (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this coverage, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Trinity Health Plan New York Cash Back (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Trinity Health Plan New York Cash Back (HMO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and diabetic therapeutic shoes. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Trinity Health Plan New York Cash Back (HMO), featuring a $40 copay and no coinsurance for diagnostic tests, alongside lab services with no copay or coinsurance. Diagnostic radiological services require a $375 copay, outpatient X-rays require a $55 copay, and therapeutic radiological services have a 20% coinsurance.
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. This ensures eligible members can receive necessary medical care in their homes at no cost.
Cardiac Rehabilitation Services See details
Trinity Health Plan New York Cash Back (HMO) covers cardiac rehabilitation services with no coinsurance, and while some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered. Copayments for these excluded services range from $15 to $30.
Skilled Nursing Facility (SNF) See details
Trinity Health Plan New York Cash Back (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and allows admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and days 61 through 100, a $218 daily copay for days 21 through 60, and additional days beyond the standard 100-day benefit are not covered.
Other Services See details
Other services are partially covered under the Trinity Health Plan New York Cash Back (HMO), which features acupuncture for a $20 copay and no coinsurance, and over-the-counter items and meal benefits with no copay and no coinsurance. Dual Eligible SNPs with Highly Integrated Services and other additional services are not covered.
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