Trinity Health Plan New York No Premium (HMO)
New York Medicare Advantage Plan (2025 Plan)
by Trinity Health Plan New York
Additional Coverage
HearingVisionDental
Overall Government Star Rating
(coming soon)
Plan Name
Trinity Health Plan New York No Premium (HMO)
Insurance Carrier
Trinity Health Plan New York
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Trinity Health Plan New York No Premium (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in New York and offered by the health insurance company Trinity Health Plan New York. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Primary doctor visit
$0 copay
Specialist visit
$30 copay per visit
ER visit
$110 copay per visit (always covered)
Trinity Health Plan New York No Premium (HMO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $6,200 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 Trinity Health Plan New York No Premium (HMO) are defined below.
Yes
Part D Prescription Drug Coverage
Trinity Health Plan New York No Premium (HMO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Trinity Health Plan New York No Premium (HMO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Trinity Health Plan New York No Premium (HMO) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Health Portion of Premium
Health Plan Max Out-of-Pocket
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Tests, labs, & imaging
Diagnostic tests & procedures
Diagnostic radiology services (like MRI)
Emergency care
$110 copay per visit (always covered)
Urgent care
$30 copay per visit (always covered)
Hospital Services
Inpatient hospital coverage
$300 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
Skilled nursing facility
Skilled nursing facility
$0 per day for days 1 through 20
$214 per day for days 21 through 55
$0 per day for days 56 through 100
Preventive services
Ambulance
Therapy services
Occupational therapy visit
Physical therapy & speech & language therapy visit
Mental health services
Outpatient group therapy with a psychiatrist
Outpatient individual therapy with a psychiatrist
Outpatient group therapy visit
Outpatient individual therapy visit
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
Prosthetics (like braces, artificial limbs)
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers | Initial coverage phase | Catastrophic coverage phase |
---|
Preferred Generic | $0.00 copay | $0 copay |
Generic | $5.00 copay | $0 copay |
Preferred Brand | 25% coinsurance | $0 copay |
Non-Preferred Drug | 50% coinsurance | $0 copay |
Specialty Tier | 33% coinsurance | $0 copay |
Part B Drugs
Hearing
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: 50% coinsurance
Out-of-network: 50% coinsurance
Endodontics
In-network: 70% coinsurance
Out-of-network: 70% coinsurance
Periodontics
In-network: 70% coinsurance
Out-of-network: 70% coinsurance
Prosthodontics, removable
Maxillofacial prosthetics
Oral and maxillofacial surgery
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay
Vision
Eyeglasses (frames & lenses)
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