MVP DualAccess (HMO D-SNP)

H3305 - 033 - 0
5 out of 5 stars (5 / 5)

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MVP DualAccess (HMO D-SNP) is a Medicare Advantage (Part C) Special Needs Plan by MVP HEALTH CARE.

This page features plan details for 2023 MVP DualAccess (HMO D-SNP) H3305 – 033 – 0 available in Western NY, Eastern NY, Hudson Valley, NY.

IMPORTANT: This page has been updated with plan and premium data for the 2023 Medicare Annual Enrollment Period (AEP).

Locations

MVP DualAccess (HMO D-SNP) is offered in the following locations.

Plan Overview

MVP DualAccess (HMO D-SNP) offers the following coverage and cost-sharing.

Special Needs Plan Type Dual-Eligible
Conditions Covered:
Insurer:MVP HEALTH CARE
Health Plan Deductible:$0.00
MOOP:$8,300 In-network
Drugs Covered:Yes
Please Note:
  • This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.
  • Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.

Ready to sign up for MVP DualAccess (HMO D-SNP) ?

Get help from a licensed Medicare agent.

Click to Call 1-877-354-4611 TTY 711. Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.

Premium Breakdown

MVP DualAccess (HMO D-SNP) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$164.90 $0.00 $0.00 $0.00 $164.90
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

MVP DualAccess (HMO D-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $505.00
Initial Coverage Limit: $4,660.00
Catastrophic Coverage Limit: $7,400.00
Drug Benefit Type: Basic
Gap Coverage: No
Formulary Link: Formulary Link

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs. The table below shows how the LIS impacts the Part D premium of this plan.
Part D LIS 25% LIS 50% LIS 75% LIS Full
$0.00 $31.70 $21.10 $10.60 $0.00

Initial Coverage Phase

After you pay your $505.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. Once you reach that amount, you will enter the next coverage phase.

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.

Tier Cost
All other tiers (Generic)25%
All other tiers (Brand-name)25%

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.

Drug TypeCost Share
Generic drugs$4.15 copay or 5% (whichever costs more)
Brand-name drugs$10.35 copay or 5% (whichever costs more)

Additional Benefits

MVP DualAccess (HMO D-SNP) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-Network: No

Dental (comprehensive)

Diagnostic services: $0 copay (limits may apply) (authorization required) (referral not required)
Endodontics: $0 copay (limits may apply) (authorization required) (referral not required)
Extractions: $0 copay (limits may apply) (authorization required) (referral not required)
Non-routine services: $0 copay (limits may apply) (authorization required) (referral not required)
Periodontics: $0 copay (limits may apply) (authorization required) (referral not required)
Prosthodontics, other oral/maxillofacial surgery, other services: $0 copay (limits may apply) (authorization required) (referral not required)
Restorative services: $0 copay (limits may apply) (authorization required) (referral not required)

Dental (preventive)

Cleaning: $0 copay (limits may apply) (authorization not required) (referral not required)
Dental x-ray(s): $0 copay (limits may apply) (authorization not required) (referral not required)
Fluoride treatment: Not covered (no limits)
Oral exam: $0 copay (limits may apply) (authorization not required) (referral not required)

Diagnostic procedures/lab services/imaging

Diagnostic radiology services (e.g., MRI): $0 copay (authorization required) (referral not required)
Diagnostic tests and procedures: $0 copay (authorization required) (referral not required)
Lab services: $0 copay (authorization required) (referral not required)
Outpatient x-rays: $0 copay (authorization required) (referral not required)

Doctor visits

Primary: $0 copay
Specialist: $0 copay (authorization required) (referral not required)

Emergency care/Urgent care

Emergency: $0 copay
Urgent care: $0 copay

Foot care (podiatry services)

Foot exams and treatment: $0 copay (authorization required) (referral not required)
Routine foot care: Not covered

Ground ambulance

$0 copay

Health plan deductible

$0.00

Health plan deductibles (other)

In-Network: No

Hearing

Fitting/evaluation: Not covered (no limits)
Hearing aids – inner ear: Not covered (no limits)
Hearing aids – outer ear: Not covered (no limits)
Hearing aids – over the ear: Not covered (no limits)
Hearing exam: $0 copay (authorization required) (referral not required)

Hospital coverage (inpatient)

$0 copay (authorization required) (referral not required)

Hospital coverage (outpatient)

$0 copay (authorization required) (referral not required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$8,300 In-network

Medical equipment/supplies

Diabetes supplies: $0 copay (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen): $0 copay (authorization required)
Prosthetics (e.g., braces, artificial limbs): $0 copay (authorization required)

Medicare Part B drugs

Chemotherapy: $0 copay (authorization required)
Other Part B drugs: $0 copay (authorization required)

Mental health services

Inpatient hospital – psychiatric: $0 copay (authorization required) (referral not required)
Outpatient group therapy visit: $0 copay (authorization required) (referral not required)
Outpatient group therapy visit with a psychiatrist: $0 copay (authorization required) (referral not required)
Outpatient individual therapy visit: $0 copay (authorization required) (referral not required)
Outpatient individual therapy visit with a psychiatrist: $0 copay (authorization required) (referral not required)

Optional supplemental benefits

No

Preventive care

$0 copay (authorization required) (referral not required)

Rehabilitation services

Occupational therapy visit: $0 copay (authorization required) (referral not required)
Physical therapy and speech and language therapy visit: $0 copay (authorization required) (referral not required)

Skilled Nursing Facility

$0 copay (authorization required) (referral not required)

Transportation

$0 copay (limits may apply) (authorization required) (referral not required)

Vision

Contact lenses: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass frames: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass lenses: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglasses (frames and lenses): $0 copay (limits may apply) (authorization not required) (referral not required)
Other: Not covered (no limits)
Routine eye exam: Not covered (no limits)
Upgrades: Not covered

Wellness programs (e.g., fitness, nursing hotline)

Covered (authorization required) (referral not required)

Ready to sign up for MVP DualAccess (HMO D-SNP) ?

Get help from a licensed Medicare agent.

Click to Call 1-877-354-4611 TTY 711. Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.

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