2022 MVP Medicare Preferred Gold without Part D (HMO-POS)

MVP Medicare Preferred Gold without Part D (HMO-POS) H3305-007 is a 2022 Medicare Advantage Plan or Part-C by MVP HEALTH CARE available to residents in New York. This plan does not provide additional prescription drug (Part-D) coverage. The MVP Medicare Preferred Gold without Part D (HMO-POS) has a monthly premium of $105.00 and has an in-network maximum out-of-pocket limit of $7,550 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,550 out-of-pocket. This can be a extremely nice safety net.

MVP Medicare Preferred Gold without Part D (HMO-POS) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered.

MVP HEALTH CARE works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for MVP Medicare Preferred Gold without Part D (HMO-POS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from MVP HEALTH CARE and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from MVP HEALTH CARE except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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Mon-Fri 8am-8pm EST
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2022 MVP HEALTH CARE Medicare Advantage Plan Costs

2021 MVP Medicare Preferred Gold without Part D (HMO-POS) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

Yes

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Comprehensive Dental

Diagnostic services	Not covered
Endodontics	Not covered
Extractions	Not covered
Non-routine services	Not covered
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	Not covered

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$30-75 copay
Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$10 copay
Diagnostic tests and procedures	30% coinsurance (Out-of-Network)
Lab services	30% coinsurance (Out-of-Network)
Lab services	$0-10 copay
Outpatient x-rays	30% coinsurance (Out-of-Network)
Outpatient x-rays	$30 copay

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Doctor Visits

Primary	30% coinsurance per visit (Out-of-Network)
Primary	$0 copay
Specialist	$30 copay per visit
Specialist	30% coinsurance per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$65 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$30 copay
Foot exams and treatment	30% coinsurance (Out-of-Network)
Routine foot care	Not covered

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Ground Ambulance

$75 copay
$75-150 copay (Out-of-Network)

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Hearing

Fitting/evaluation	$0 copay
Hearing aids	$699-999 copay
Hearing exam	$30 copay
Hearing exam	30% coinsurance (Out-of-Network)

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Inpatient Hospital Coverage

30% per stay (Out-of-Network)
$365 per day for days 1 through 5 $0 per day for days 6 through 90

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Medical Equipment/Supplies

Diabetes supplies	$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)	30% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	0-20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	30% coinsurance per item (Out-of-Network)

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Medicare Part B Drugs

Chemotherapy	20% coinsurance
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	$350 per day for days 1 through 5 $0 per day for days 6 through 90
Inpatient hospital - psychiatric	Not Applicable (Out-of-Network)
Outpatient group therapy visit	$30 copay
Outpatient group therapy visit with a psychiatrist	$30 copay
Outpatient individual therapy visit	$30 copay
Outpatient individual therapy visit with a psychiatrist	$30 copay

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MOOP

$7,550 In-network

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Option

Yes, contact plan for further details

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Optional supplemental benefits

Yes

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Outpatient Hospital Coverage

$250 copay per visit
30% coinsurance per visit (Out-of-Network)

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Package #1

Deductible	$100.00
Monthly Premium	$28.00

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Preventive Care

$0 copay
30% coinsurance (Out-of-Network)

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Preventive Dental

Cleaning	Not covered
Dental x-ray(s)	Not covered
Fluoride treatment	Not covered
Oral exam	Not covered

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Rehabilitation Services

Occupational therapy visit	$20 copay
Occupational therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$20 copay

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Skilled Nursing Facility

Not Applicable (Out-of-Network)
$0 per day for days 1 through 20 $184 per day for days 21 through 100

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Transportation

Not covered

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Vision

Contact lenses	$0 copay
Eyeglass frames	$0 copay
Eyeglass lenses	$0 copay
Eyeglasses (frames and lenses)	$0 copay
Other	Not covered
Routine eye exam	30% coinsurance (Out-of-Network)
Routine eye exam	$20 copay
Upgrades	$0 copay

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for MVP Medicare Preferred Gold without Part D (HMO-POS) H3305

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in MVP Medicare Preferred Gold without Part D (HMO-POS) Plans Performance

Health Plan Customer Service Rating for MVP Medicare Preferred Gold without Part D (HMO-POS)

MVP Medicare Preferred Gold without Part D (HMO-POS) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

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

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.