MVP Preferred Gold without Part D (HMO-POS)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by MVP HEALTH CARE
Additional Coverage
Hearing Vision
Overall Government Star Rating
 4.0
out of 5 stars

State: Vermont

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B

 

$62
$62
$0
$0
$6,700 In-network
No
Yes
Yes
No

Medical Benefits

Doctor Services

In-network: $15 per visit
Out-of-network: 30% per visit
In-network: $30 per visit
Out-of-network: 30% per visit

Tests, labs, & imaging

In-network: $10
Out-of-network: 30%
In-network: $0-10
Out-of-network: 30%
In-network: $30-60
Out-of-network: 30%
In-network: $30
Out-of-network: 30%
$90 per visit (always covered)
$50 per visit (always covered)

Hospital Services

In-network: $350 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: 30% per stay
In-network: $250 per visit
Out-of-network: 30% per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-network: Not Applicable

Preventive services

In-network: $0 copay
Out-of-network: 30%

Ambulance

In-network: $100
Out-of-network: $100-200

Therapy services

In-network: $20
Out-of-network: 30%
In-network: $20
Out-of-network: 30%

Mental health services

In-network: $30
Out-of-network: No Data
In-network: $30
Out-of-network: No Data
In-network: $30
Out-of-network: No Data
In-network: $30
Out-of-network: No Data

Opioid treatment services

Covered

Other services

In-network: 20% per item
Out-of-network: 30% per item
In-network: 0-20% per item
Out-of-network: 30% per item
In-network: 10-20% per item
Out-of-network: No Data

Prescription Drug Benefits

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

Part B Drugs

In-network: 0-20%
Out-of-network: No Data
In-network: 0-20%
Out-of-network: No Data

Extra Benefits

Hearing

In-network: $30
Out-of-network: 30%
In-network: $0 copay
Out-of-network: No Data
In-network: $699-999
Out-of-network: No Data

Preventive Dental

Not covered
Not covered
Not covered
Not covered

Comprehensive dental

Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered

Vision

In-network: $20
Out-of-network: 30%
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data

Other benefits

Limited coverage
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
Not covered
 4
 4
 3
 5
 4
 4

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