MVP Medicare Preferred Gold without Part D (HMO-POS)

H3305 - 020 - 0
4.5 out of 5 stars (4.5 / 5)

MVP Medicare Preferred Gold without Part D (HMO-POS) is a Medicare Advantage (Part C) Plan by MVP HEALTH CARE.

This page features plan details for 2024 MVP Medicare Preferred Gold without Part D (HMO-POS) H3305 – 020 – 0 available in S.Tier NY, CNY, Eastern NY, Hudson Valley NY, VT.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

MVP Medicare Preferred Gold without Part D (HMO-POS) is offered in the following locations.

Plan Overview

MVP Medicare Preferred Gold without Part D (HMO-POS) offers the following coverage and cost-sharing.

Insurer:MVP HEALTH CARE
Health Plan Deductible:$0.00
MOOP:$6,700 In-network
Drugs Covered:No

Ready to sign up for MVP Medicare Preferred Gold without Part D (HMO-POS) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

Premium Breakdown

MVP Medicare Preferred Gold without Part D (HMO-POS) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$174.70 $0.00 $0.00 $174.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

MVP Medicare Preferred Gold without Part D (HMO-POS) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

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

$6,700 In-network

Optional supplemental benefits

No

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

In-network Yes, contact plan for further details

Outpatient hospital coverage

In-network $250 copay per visit (Authorization is required.) (Referral is not required.)
out-of-network 30% coinsurance per visit (Authorization is required.) (Referral is not required.)

Doctor visits

In-network Primary$0 copay (Not applicable.) (Not applicable.)
out-of-network Primary30% coinsurance per visit (Not applicable.) (Not applicable.)
In-network Specialist$30 copay per visit (Authorization is required.) (Referral is not required.)
out-of-network Specialist30% coinsurance per visit (Authorization is required.) (Referral is not required.)

Preventive care

In-network $0 copay (Authorization is not required.) (Referral is not required.)
out-of-network 30% coinsurance (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$95 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$55 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

In-network Diagnostic tests and procedures$10 copay (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic tests and procedures30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Lab services$0-10 copay (Authorization is required.) (Referral is not required.)
out-of-network Lab services30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Diagnostic radiology services (e.g., MRI)$30-100 copay (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic radiology services (e.g., MRI)30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient x-rays$30 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient x-rays30% coinsurance (Authorization is required.) (Referral is not required.)

Hearing

In-network Hearing exam$0 copay (Authorization is not required.) (Referral is not required.)
out-of-network Hearing exam30% coinsurance (Authorization is not required.) (Referral is not required.)
In-network Fitting/evaluation$0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)
In-network Hearing aids$699-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Preventive dental

In-network Oral exam$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Oral exam20-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Cleaning$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Cleaning20-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Fluoride treatment$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Fluoride treatment20-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Dental x-ray(s)20-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)

Comprehensive dental

In-network Non-routine services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Non-routine services20-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Diagnostic services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic services20-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Restorative services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Restorative services20-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Endodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Endodontics20-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Periodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Periodontics20-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Extractions$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Extractions20-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Prosthodontics, other oral/maxillofacial surgery, other services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Prosthodontics, other oral/maxillofacial surgery, other services20-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)

Vision

In-network Routine eye exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Routine eye exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Eyeglass frames$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Eyeglass lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Upgrades$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Rehabilitation services

In-network Occupational therapy visit$20 copay (Authorization is required.) (Referral is not required.)
out-of-network Occupational therapy visit30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Physical therapy and speech and language therapy visit$20 copay (Authorization is required.) (Referral is not required.)
out-of-network Physical therapy and speech and language therapy visit30% coinsurance (Authorization is required.) (Referral is not required.)

Ground ambulance

In-network $100 copay (Not applicable.) (Not applicable.)
out-of-network $100-200 copay (Not applicable.) (Not applicable.)

Transportation

In-network $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Foot care (podiatry services)

In-network Foot exams and treatment$30 copay (Authorization is required.) (Referral is not required.)
out-of-network Foot exams and treatment30% coinsurance (Authorization is required.) (Referral is not required.)
Routine foot careNot covered (Not applicable.) (Not applicable.)

Medical equipment/supplies

In-network Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item (Authorization is required.) (Not applicable.)
out-of-network Durable medical equipment (e.g., wheelchairs, oxygen)30% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Prosthetics (e.g., braces, artificial limbs)0-20% coinsurance per item (Authorization is required.) (Not applicable.)
out-of-network Prosthetics (e.g., braces, artificial limbs)30% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Diabetes supplies$0 copay (Authorization is required.) (Not applicable.)

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

Covered (Authorization is required.) (Referral is not required.)

Medicare Part B drugs

In-network Chemotherapy0-20% coinsurance (Authorization is required.) (Not applicable.)
In-network Other Part B drugs0-20% coinsurance (Authorization is required.) (Not applicable.)
In-network Part B Insulin drugs0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

In-network $350 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)
out-of-network 30% per stay (Authorization is required.) (Referral is not required.)

Mental health services

In-network Inpatient hospital – psychiatric$350 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)
out-of-network Inpatient hospital – psychiatricNot Applicable (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit with a psychiatrist$30 copay (Authorization is required.) (Referral is not required.)
In-network Outpatient individual therapy visit with a psychiatrist$30 copay (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit$30 copay (Authorization is required.) (Referral is not required.)
In-network Outpatient individual therapy visit$30 copay (Authorization is required.) (Referral is not required.)

Skilled Nursing Facility

In-network $0 per day for days 1 through 20
$203 per day for days 21 through 100 (Authorization is required.) (Referral is not required.)
out-of-network Not Applicable (Authorization is required.) (Referral is not required.)

Ready to sign up for MVP Medicare Preferred Gold without Part D (HMO-POS) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

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