CDPHP Core (HMO)

New York Medicare Advantage Plan (2025 Plan)


Monthly Premium

Your Cost
$15
by CDPHP Medicare Advantage

Additional Coverage

HearingVisionDental

Overall Government Star Rating

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Plan Name
CDPHP Core (HMO)
Insurance Carrier
CDPHP Medicare Advantage
Plan Type
Medicare Advantage Plan Without Prescription Drugs
Network Type
HMO

CDPHP Core (HMO) is a Medicare Advantage Plan Without Prescription Drugs, which is available in New York and offered by the health insurance company CDPHP Medicare Advantage. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$15
Annual Deductible
$0
Max Out-of-Pocket
$6,100
Primary doctor visit
$0 copay
Specialist visit
$0-25 copay per visit
ER visit
$90 copay per visit (always covered)
Ambulance
$165 copay

CDPHP Core (HMO) has a monthly premium cost of $15 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $6,100 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for CDPHP Core (HMO) are defined below.

No
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

CDPHP Core (HMO) is a Medicare Advantage plan which does not include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. CDPHP Core (HMO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. CDPHP Core (HMO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Limited coverage
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Monthly Premium
$15
Health Portion of Premium
$15
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$6,100 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$0-25 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$0-25 copay
Lab services
$0-5 copay
Diagnostic radiology services (like MRI)
$100 copay
Outpatient x-rays
$25 copay
Emergency care
$90 copay per visit (always covered)
Urgent care
$45 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$260 per day for days 1 through 6
$0 per day for days 7 through 90
Outpatient hospital coverage
$200 copay per visit

Skilled nursing facility

Skilled nursing facility
$0 per day for days 1 through 20
$120 per day for days 21 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$165 copay

Therapy services

Occupational therapy visit
$25 copay
Physical therapy & speech & language therapy visit
$25 copay

Mental health services

Outpatient group therapy with a psychiatrist
$25 copay
Outpatient individual therapy with a psychiatrist
$25 copay
Outpatient group therapy visit
$25 copay
Outpatient individual therapy visit
$25 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
20% coinsurance per item
Prosthetics (like braces, artificial limbs)
20% coinsurance per item
Diabetes supplies
$10 copay or 0-20% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Part B Drugs

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
$35 copay or 0-20% coinsurance

Hearing

Hearing exam
$25 copay
Fitting/evaluation
$0 copay
Hearing aids - All types
$199-499 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: $0 copay
Maxillofacial prosthetics
In-network: $0 copay
Out-of-network: $0 copay
Implant services
In-network: $0 copay
Out-of-network: $0 copay
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Orthodontics
In-network: $0 copay
Out-of-network: $0 copay
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
Not covered

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