MVP HEALTH PLAN 2024 Medicare Advantage Plans User Manual
- May 15, 2024
- MVP HEALTH PLAN
Table of Contents
- MVP HEALTH PLAN 2024 Medicare Advantage Plans
- Product Information
- Product Usage Instructions
- Let’s talk
- More Information
- MVP Care Guides
- Well-Being Benefits and Extras
- Benefits at a Glance
- Part D Prescription Drug Coverage
- INITIAL COVERAGE STAGE
- COVERAGE GAP STAGE
- CATASTROPHIC COVERAGE STAGE
- Read User Manual Online (PDF format)
- Download This Manual (PDF format)
MVP HEALTH PLAN 2024 Medicare Advantage Plans
Product Information
- Specifications
- MVP Medicare Advantage Plans
- MVP Medicare with Part D
- MVP Medicare without Part D
- 10 visits per year
- $2,000 per year for covered dental services
- Hearing Aid Coverage:
- Pay $699 or $999 per hearing aid
- Or get up to $600 per hearing aid toward your choice of top models, rechargeable or batteries included
- Dental Coverage:
- $175 per year
- $225 per year
- $225 per year
- Transportation Coverage:
- $75 per quarter (18 one-way rides per year)
- $100 per quarter (30 one-way rides per year)
- $50 per quarter (12 one-way rides per year)
- Refrigerated Meals:
- 14 free refrigerated meals after an in-patient hospital stay discharge
- Virtual Care:
- $0 virtual care to address an immediate or same-day health need, available 24/7
- Gym Membership:
- Enjoy a free gym membership to 16,000 fitness locations nationwide
- Access to a full library of on-demand videos
- Live online classes
- The GetSetUp online learning community
- Annual Wellness Visit:
- Earn a $100 gift card reward for completing your annual wellness visit
Product Usage Instructions
- Understanding Your Plan
- It is important to understand the details of your MVP Medicare Advantage plan to make the most of your benefits. Refer to the specifications section above for specific coverage details and benefit limits.
- Using Dental Services
- If your plan includes dental coverage, you can receive up to $2,000 per year for covered dental services. Make sure to choose a dental provider within your plan’s network to maximize your benefits.
- Hearing Aid Coverage
- If you require hearing aids, you have two options:
- Pay $699 or $999 per hearing aid
- Get up to $600 per hearing aid toward your choice of top models, rechargeable or batteries included
- Consult with your MVP Care Guide or contact customer service for more information on how to utilize this benefit.
- Transportation Coverage
- If you need transportation for medical appointments, your plan provides coverage for a certain number of one-way rides per year.
- The number of rides and the corresponding cost per quarter are listed in the specifications section above.
- Contact customer service or your MVP Care Guide to arrange transportation services.
- Refrigerated Meals
- After being discharged from an in-patient hospital stay, you are eligible for 14 free refrigerated meals.
- Contact customer service or your MVP Care Guide to arrange the delivery of these meals.
- Virtual Care
- If you have an immediate or same-day health need, you can access virtual care services 24/7 at no cost.
- Contact customer service or your MVP Care Guide for instructions on how to use this service.
- Gym Membership
- Enjoy a free gym membership to 16,000 fitness locations nationwide.
- Additionally, you have access to a full library of on-demand videos, live online classes, and the GetSetUp online learning community.
- Contact customer service or your MVP Care Guide for instructions on how to activate your gym membership and access these resources.
- Annual Wellness Visit
- Completing your annual wellness visit can earn you a $100 gift card reward. Schedule an appointment with your primary care provider and make sure to mention that you are eligible for this reward.
- FAQ
- Q: How can I find a dental provider within my plan’s network?
- A: You can find a list of dental providers in your plan’s network by visiting the MVP Healthcare website or by contacting customer service.
- Q: Can I use my transportation coverage for non-medical purposes?
- A: No, the transportation coverage provided by your plan is specifically for medical appointments and should not be used for non-medical purposes.
- Q: Are there any restrictions on virtual care services?
- A: Most members can access virtual care services through Gia at no cost-share. However, in-person visits and referrals may be subject to cost-share per plan. Contact customer service or your MVP Care Guide for more information.
- Q: How do I activate my gym membership?
- A: Contact customer service or your MVP Care Guide for instructions on how to activate your gym membership and access the available resources.
Let’s talk
- Have questions or need more information?
- Call 1-800-324-3899 (TTY 711)
- October 1–March 31, seven days a week, 8 am–8 pm Eastern Time.
- April 1–September 30, call Monday–Friday, 8 am–8 pm.
- Or visit mvphealthcare.com/medicare.
More Information
- MVP Health Plan, Inc. complies with Federal civil rights laws. MVP Health Plan, Inc. does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex (including sexual orientation and gender identity).
- If your coverage is through an employer-sponsored plan, check with the former employer for your benefit information. This is not a contract. These benefit charts are for general reference only. All benefits are subject to federal Medicare program medical necessity guidelines.
- MVP Health Plan, Inc. is an HMO-POS/PPO organization with a Medicare contract. Enrollment in MVP Health
- The plan depends on contract renewal. Out-of-network/ non-contracted providers are under no obligation to treat MVP Health Plan members, except in emergencies. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
- For accommodations of persons with special needs at meetings, call 1-800-324-3899 (711).
- MVP virtual care services through Gia are available at no cost-share for most members. In-person visits and referrals are subject to cost-share per plan.
- SilverSneakers is a registered trademark of Tivity Health,
- Inc. SilverSneakers On-Demand is a trademark of Tivity
- Health, Inc. ©2023 Tivity Health, Inc. All rights reserved.
- GetSetUp is a third-party provider and is not owned or operated by Tivity Health, Inc. (“Tivity”) or its affiliates.
- Users must have Internet service to access online services.
- Internet service charges are the responsibility of the user.
- TruHearing® and (RE)™ are trademarks of TruHearing, Inc.
- All other trademarks, product names, and company names are the property of their respective owners. Retail pricing is based on prices for comparable aids. Follow-up provider visits included for one year following hearing aid purchase.
- The free battery offer does not apply to the purchase of rechargeable hearing aid models. Three-year warranty includes repairs and one-time loss and damage replacement. Hearing aid repairs and replacements are subject to provider and manufacturer fees.
- For questions regarding fees, contact a TruHearing hearing consultant.
- Y0051_8570_M MVPMCR0032 (07/2023) ©2023 MVP Health Care
MVP Care Guides
- Get extra support from our expert Care Guides as you get started with an MVP Medicare Advantage plan.
- They are available to offer personalized guidance to make sure you understand your plan, are ready to use your benefits, and ensure there is no disruption to your health care.
MVP MEDICARE ADVANTAGE PLANS
- In-network provider: 0 % co-insurance for covered services
- Out-of-network provider: 20 %–50 % co-insurance for covered services
Choose the right coverage for you!
- Pay $699 or $999 per hearing aid, or get up to $600 per hearing aid toward your choice of top models, rechargeable or batteries included
| $175 per year | $225 per year | $225 per year |
|---|---|---|
| $75 per quarter | $100 per quarter | $50 per quarter |
| 18 one-way rides per year | 30 one-way rides per year | 12 one-way rides per |
year
14 free refrigerated meals after an in-patient hospital stay discharge $0 virtual care to address an immediate or same-day health need, available 24 / 7 Enjoy a free gym membership to 16,000 fitness locations nationwide, plus, get access to a full library of on-demand videos, live online classes, and the GetSetUp online learning community Earn a $100 gift card reward for completing your annual wellness visit Look inside for at-a-glance plan comparisons.
Well-Being Benefits and Extras
MVP is committed to supporting you along every step of your health journey. Our Medicare Advantage plans include extra benefits, programs, and services to help you live your best life.
For detailed benefit information, refer to the MVP MEDICARE ADVANTAGE PLANS brochure.
Benefits at a Glance
MVP MEDICARE ADVANTAGE PLANS Benefits at a Glance
Doctor Visits
Primary Care| IN $0 co-pay | OUT $40 co-pay| $0 copay| IN
$0 co-pay | OUT $5 co-pay| IN $0 co-pay | OUT $60 co-pay| $0
copay| $0 copay
---|---|---|---|---|---|---
Specialist No Referrals!| IN $50 co-pay | OUT $60 co-pay| $45
copay| IN $40 co-pay | OUT $50 co-pay| IN $45 co-pay | OUT
$60 co-pay| $40 copay| $30 copay
Mental Health Specialist| IN $10 co-pay | OUT $60 co-pay| $10
copay| IN $10 co-pay | OUT $50 co-pay| IN $10 co-pay | OUT
$60 co-pay| $10 copay| $30 copay
Gia ® Virtual Care Services| $0 copay| $0 copay| $0 copay| $0
copay| $0 copay| $0 copay
Routine Eye Exams| IN $0 co-pay | OUT $0 co-pay| $0
copay| IN $0 co-pay | OUT $0 co-pay| IN $0 co-pay | OUT $0
co-pay| $0 copay| $0 copay
Routine Hearing Exams| IN $0 co-pay | OUT $60 co-pay| $0
copay| IN $0 co-pay | OUT $60 co-pay| IN $0 co-pay | OUT $60
co-pay| $0 copay| $0 copay
Chiropractic| IN $10 co-pay | OUT $20 co-pay| $15 copay| IN
$10 co-pay | OUT $20 co-pay| IN $15 co-pay | OUT $20 co-pay| $15
copay| $15 copay
Outpatient Physical, Speech, and Occupational
Therapy| IN $40 co-pay | OUT $60 co-pay| $40 copay| IN $40
co-pay | OUT $60 co-pay| IN $40 co-pay | OUT $60 co-pay| $20
copay| $20 copay
Emergency Care Worldwide Coverage
Emergency Room Care| $100 co-pay
$95 co-pay| $95 copay| $95 copay| $95 copay| $95 copay
---|---|---|---|---|---
Urgently Needed Care| $30 co-pay
$30 co-pay| $30 copay| $40 copay| $30 copay| $50 copay
Ambulance (Ground)| $250 co-pay
$250 co-pay| $150 copay| $200 copay| $160 copay| $75 copay
Out-of-Network Coverage All plans include coverage for non-emergency care from Medicare providers anywhere in the United States who are not part of the MVP Medicare provider network.
Non-urgent and Non-Emergency Services and Admissions
Some services excluded
| Up to $60 co-pay for office visits,
30% co-insurance, MVP pays 70%, 40% co-insurance for others up to $2,500 per
year| Up to $60 co-pay for office visits, 40% co-insurance for other| Up to
$60 co-pay for office visits, 40% co-insurance for other| 30% co-insurance,
MVP pays 70%, up to $4,000 per year| 30% co-insurance, MVP pays 70%, up to
$4,000 per year
---|---|---|---|---|---
Hospital, Surgery, and Rehabilitation Services All plans cover skilled nursing facility care at a post-acute rehabilitation center.
Inpatient Hospital Stays
Emergency admissions are covered worldwide
| IN $400 per day for days 1–5, $350 per day for days 1–5,
then $0 per day for days 6+ then $0 per day for days 6+
OUT 40% co-insurance
| IN $400 per day for days 1–5, then $0 per day for days 6+ OUT 40%
co-insurance| IN $340 per day for days 1–5, then $0 per day for days 6+
OUT 40% co-insurance| $365 per day for days 1–5, then $0 per day for days
6+| $345 per day for days 1–5, then $0 per day for days 6+
---|---|---|---|---|---
Observation Stays Not inpatient admission| IN $300 co-pay |
OUT 40% co-insurance
$350 co-pay| IN $325 co-pay | OUT 40% co-insurance| IN $300 co-
pay | OUT 40% co-insurance| $325 copay| $250 copay
Outpatient Hospital/Ambulatory Surgical Center
(Same-day surgery)
| IN $300/$300 co-pay $350 co-pay | $300 co-pay
OUT 40% co-insurance
| IN $325/$200 co-pay
OUT 40% co-insurance
| IN $400/$300 co-pay
OUT 40% co-insurance
| $325 co-pay/$225 co-pay| $250 co-pay/$125 co-pay
Diagnostic Services Office visit co-pay may apply.
- May be lower with New York State EPIC and/or Low Income Subsidy assistance. You must continue to pay your Part B premium.
- The most you pay for covered medical services in a calendar year, excluding Part D drug costs. If you reach the maximum amount, MVP pays 100 % of the cost of covered services, including Part D drugs, through December 31.
Part D Prescription Drug Coverage
INITIAL COVERAGE STAGE
- After your deductible is met, you pay your cost-share for covered prescription drugs.
- Your cost for a 30-day supply from a participating retail pharmacy is below.
- Or save money using the CVS Caremark Mail Service Pharmacy.
- A three-month supply of many prescriptions is available for only two co-pays. Refer to the Medicare Part D Formulary for details.
TIER 1| $0
No Deductible
| $0
No Deductible
| $0
No Deductible
| $0
No Deductible
| $0
---|---|---|---|---|---
TIER 2| $12
No Deductible
| $15
No Deductible
| $15
No Deductible
| $10
No Deductible
| $10
TIER 3| $42
After Deductible
| $47
After Deductible
| $45
After Deductible
| $47
After Deductible
| $40
TIER 4| $100
After Deductible
| 25%
After Deductible
| 25%
After Deductible
| 25%
After Deductible
| 25%
TIER 5| 27%
After Deductible
| 25%
After Deductible
| 27%
After Deductible
| 25%
After Deductible
| 33%
COVERAGE GAP STAGE
If your total drug costs in 2024 reach $5,030, your cost for prescription
drugs changes.
You pay:
- All Tiers: 25% for generic and contracted brand-name drugs
- All Tiers: 25% for generic and contracted brand-name drugs
- All Tiers: 25% for generic and contracted brand-name drugs
- All Tiers: 25% for generic and contracted brand-name drugs
- Tier 1: $0 Tiers 2–5: 25% for generic and contracted brand name drugs
CATASTROPHIC COVERAGE STAGE
If your true out-of-pocket costs reach $8,000, you will pay $0 for all drugs in all tiers for the rest of the calendar year. Drugs purchased outside the United States are not Medicare-approved and are not covered. Members living with diabetes have extra support. Plan-covered insulin drugs are not subject to Part D deductibles and are covered at a maximum $35 co-pay or the tier co- pay, whichever is less. OneTouch, FreeStyle, Precision, and Prodigy brand diabetic supplies are covered with a $0 co-pay.