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Contact Us

MVP Medicare Customer Care Center
1-800-665-7924
TTY: 1-800-662-1220

Hours

Monday - Friday

8 am - 8 pm and

Saturday, 8 am to 4 pm (EST)

From Oct. 1 - Feb 14, call seven days a week, 8 am to 8 pm

 

MVP Medicare Sales
1-888-280-6205
TTY: 1-800-662-1220

Hours

Monday - Friday, 8 am - 5 pm (EST)

 

Address

220 Alexander St.

Rochester, NY 14607

 

24/7 Nurse Advice Line

1-800-204-4712

 

Expedited Coverage Determination

1-800-665-7924

 

Coverage Determination Exception

Fax:1-800-401-0915

GoldAnywhere with Part D Option 1 and Option 2 (PPO) — We do Medicare. You Relax.

4.5 Stars Rating Image

4.5 Star Rated Medicare Plans

What you get with GoldAnywhere:

  • $0-cost commonly used generic drugs.
  • No specialist referrals or special permission needed.
  • Worldwide coverage for emergency room care.
  • More than 19,000 MVP doctors and hospitals, from Buffalo, NY to Burlington, VT.
  • Freedom to see any doctor (you may pay more for doctors who are not contracted with MVP).
  • Full coverage for preventive care, such as annual physicals and mammograms.
  • A complimentary $0-cost Healthways SilverSneakers® Fitness program membership.
  • Coverage for acupuncture services.
  • $100 HealthDollarsSM to spend each year on healthy activities.
  • One convenient monthly bill and virtually no paperwork.
  • A dedicated team experienced in Medicare Advantage health plans.

Note: If your coverage is through an employer sponsored plan, all benefits may not apply.

 

2014 Benefits

Annual out-of-Pocket Max for your protection (once met, MVP pays 100% of covered services)

GoldAnywhere with
Part D Option 1
$2,000 IN, $5,000 combined IN and OUT, excluding acupuncture, eye wear, dental, hearing aid, and Part D drug costs

GoldAnywhere with

Part D Option 2
$4,000 IN, $10,000 combined IN and OUT, excluding acupuncture, and Part D drug costs

IN=In-Network, OUT= Out-of-Network

Monthly premium with prescription drug coverage

$238.00

$64.00

PCP copay

IN - $10 / OUT - $35

IN - $25 / OUT - $60

Specialist copay

IN - $15 / OUT - $35

IN - $50 / OUT - $60

Inpatient Hospital copay

IN - $150 per stay, max $450/year;
OUT - 25% coinsurance

IN - $750 per stay, max $2,250/year;
OUT - 40% coinsurance

Lab

IN - covered in full

OUT 25% coinsurance

IN - $0 preventive / $10 maintenance

OUT 40 % coinsurance

X-rays

IN - $15 / $35 OUT

IN - $50 / OUT - $60

Other radiology services (CT scan, PET scan, MRI)
IN - $15 / OUT - 25% coinsurance
IN - $60 / OUT - 40% coinsurance

Skilled nursing facility

IN - $50/day for days 1-20,
$150/day for days 21-100
OUT 25% coinsurance

IN - $25/day for days 1-20,
$150/day for days 21-100
OUT 40% coinsurance

Outpatient services copay

IN - covered in full
OUT - 25% coinsurance

IN - $250 Ambulatory Surgery

$500 Outpatient Hospital
OUT - 40% coinsurance

Home care

IN - covered in full
OUT 25% coinsurance

IN - covered in full
OUT 40% coinsurance

Diabetic testing and insulin pump supplies

IN - 10% coinsurance

OUT - 25% coinsurance

IN - 10% coinsurance

OUT - 40% coinsurance

Eye wear *

$100 allowance every two years

N/A

Hearing aids

$600 allowance/3 yrs

N/A

Dental *

$300 allowance per year for preventive dental services

N/A

Out of network coverage

No deductible; $35 office visit; 25% coinsurance for most other services; out-of-pocket protection applies

No deductible; $60 office visit; 40% coinsurance for most other services; out-of-pocket protection applies

HealthDollarssm *

$100 HealthDollars per year

$100 HealthDollars per year

Part D prescription benefit

Retail: $8/$35/$90/33%/$0
No deductible

Mail order: 2x for a 90-day supply

Retail: $10/$35/$90/33%/$0
No deductible

Mail order: 2x for a 90-day supply

Other Included Benefits and Services

Healthways SilverSneakers® Fitness program - fitness center membership benefits (includes Curves® )

24/7 Nurse Advice Line

MVP health, nutritional and wellness resources

SilverSneakers® is a registered trademeark of Healthways, Inc.

* Any unused portion of these benefits cannot carry over from one calendar year to the next.

 

Part D Prescription Drug Coverage

Find a Drug – 2014 Comprehensive Medicare Part D Covered Drugs (Formulary)

 

GoldAnywhere with Part D Option 1 and Option 2 offer the convenience of both medical and Part D prescription drug coverage together in one plan. Do not join a separate Part D plan for your prescription drug coverage. If you do, Medicare will disenroll you out of your MVP plan.

 

MVP’s coverage for medically necessary Medicare Part D approved drugs includes:

Initial Coverage Stage
During this stage, you pay your Tier copay or coinsurance for covered prescription drugs.

Retail Pharmacy (30 day supply)

Express Scripts Mail Order
(90 day supply)

Tier 1 – Preferred Generic Drugs

$8 – Option 1
$10 – Option 2

$16 – Option 1
$20 – Option 2

Tier 2 – Preferred Brand Name Drugs

$35

$70

Tier 3 – Non-preferred Brand Name and Non-preferred Generic Drugs

$90

$180

Tier 4 – Specialty Drugs

33%

33%

Tier 5 – Select Care Drugs

$0

$0

Part D drugs excluded from our Formulary must go through an exception process in order to be covered. If they are approved, they will be covered in Tier 3.

Coverage Gap Stage

Once your total drug expenses in 2014 reach $2,850, you will pay 72% for generic drugs, 47.5% for Medicare-contracted brands, 100% for non-Medicare contracted brands.  You will continue to pay $0 for Tier 5 drugs.

Catastrophic Coverage Stage

When you have paid $4,550 out of pocket in 2014, your cost for prescriptions is reduced to the greater of 5% or $2.55 for generics and $6.35 for brand-name drugs in Tiers 1 - 4. You will continue to pay $0 for Tier 5 drugs.

Non-Part D drugs are not covered.

If you are taking a Tier 5 medication, it will be $0 in the initial coverage phase, coverage gap or “donut hole” and catastrophic coverage phase.

Note: Not all Part D drugs are available through the mail. Costs for Part B drugs and supplies are 20%. Drugs purchased outside the U.S. are not Medicare approved and are not covered.

 


MVP Health Plan, Inc. is a not-for-profit HMO-POS/PPO organization with a Medicare contract. Enrollment in MVP Health Plan depends on contract renewal. Plan availability and premium rates may vary by county.

 

The benefit information provided is a brief summary, not a comprehensive description of benefits.  For more information, contact the plan.  Limitations, copayments and restrictions may applyBenefits, Formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year. You must have both Part A and Part B to enroll, and continue to pay your Part B premium. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

 

PPO members may see doctors within and outside the MVP network. However, with the exception of emergencies or urgent care, it will cost more to get care from OUT providers. You must use network pharmacies to access your prescription drug benefit.

 

 

Last updated: November 2013

 

 

 

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