Univera Medicare Dual (HMO D-SNP) Costs & Coverage, Erie County, New York
Univera Medicare Dual (HMO D-SNP) Costs & Coverage, Erie County, New York
Discover how Univera Medicare Dual (HMO D-SNP) stands out as a 2025 Special Needs Plan (SNP), offering tailored coverage to fit your individual needs. This page provides a comprehensive look at the plan’s benefits and costs, helping you make an informed choice.
Delivery of healthcare services and costs by Excellus Health Plan Community Care LLC are different than Original Medicare. This private health insurance option, available to qualified individuals in Erie County, NY, may include additional benefits that are not provided by Medicare Part A and Part B.
As of May 31, 2025, plan enrollments topped 58 members, with 58 in Erie County, New York.
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. The Excellus Health Plan Community Care LLC logo is a registered trademark.[2]
Univera Medicare Dual Overview
| Plan ID H7524-001-0 Overview | |
|---|---|
| Health Plan ID: | H7524-001-0 |
| Medicare Advantage Plan Type: | HMO D-SNP |
| Plan Year: | 2025 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $9,350.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $590.00 deductible |
| Additional Benefits: | Vision, Hearing |
| Availability: | Erie County, NY |
| Insured By: | Excellus Health Plan Community Care LLC |
We're Here to Help You Enroll
Health Plan Cost Sharing & Benefits
Univera Medicare Dual is a Health Maintenance Organization (HMO) plan. As an HMO member, you typically receive healthcare services through the plan’s local network of providers, with referrals generally required to see specialists and other providers. However, Univera Medicare Dual does cover out-of-network care for emergencies and out-of-area dialysis.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $0 Copay |
| Specialist: | $0 Copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $0 Copay |
| Urgent care: | $0 Copay |
| Ground ambulance: | $0 Copay |
| Inpatient hospital care: | $400.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $214.00 per day for days 21 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $0 Copay |
| Routine Foot Care: | $0 Copay |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $0 Copay |
| Routine chiropractic: | $0 Copay |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $0 Copay |
| Outpatient group therapy: | $0 Copay |
| Inpatient psychiatric hospital care: | $374.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $0 Copay Prior Authorization Required |
| Occupational therapy: | $0 Copay Prior Authorization Required |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | $0 Copay Prior Authorization Required |
| Durable medical equipment: | $0 Copay Prior Authorization Required |
| Prosthetics: | $0 Copay |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $0 Copay Prior Authorization Required |
| Lab services: | $0 Copay Prior Authorization Required |
| Outpatient x-rays: | $0 Copay Prior Authorization Required |
| Diagnostic tests and procedures: | $0 Copay Prior Authorization Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | $0 Copay |
| Other Part B drugs (Medicare-covered): | $0 Copay |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | Not Covered |
| Oral exam | |
| Dental x-rays | |
| Cleaning | |
| Periodontics | |
| Endodontics | |
| Restorative Services |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | Covered Limits may apply |
| Hearing aids | Covered Limits may apply |
| Hearing exam | Covered Limits may apply |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | 20% Coinsurance |
| Routine eye exam (in-network) | Covered Limits may apply |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: No Eyeglass Frames: No Eyewear Upgrades: No |
| Maximum eyewear benefit: | $200.00 Every year |
Do you have questions about the costs in this plan? Call 1-833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Fri 5am-6pm, Sat 6am-5pm PST) and learn more about this Special Needs Plan (H7524-001-0) and other plans on this site.
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $22.40 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $22.40 |
| Low Income Premium Subsidy: | $72.34 |
| Low Income Premium Subsidy CMS Pays: | $22.40 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $590.00. This is the amount you must pay at the pharmacy before Excellus Health Plan Community Care LLC begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Univera Medicare Dual has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 | $0.00 |
| Generic | $20.00 | $20.00 |
| Preferred Brand | $47.00 | $47.00 |
| Non-Preferred Drug | 35.00% | 35.00% |
| Specialty Tier | 25.00% | 25.00% |
| *Deductible does not apply. | ||
5-Star Rating Marks
Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Advantage HMO D-SNPs across nine broad categories using a 5-star rating system. These star ratings provide insight into the quality of care and service you can expect from this Excellus Health Plan Community Care LLC plan.
CMS Star Ratings for Plan H7524-001-0 – 2025
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
How to Qualify for Enrollment in Univera Medicare Dual
To enroll in Univera Medicare Dual you must qualify for both Medicare and Medicaid and live in one of the plan's service areas. Eligibility for Medicare requires you to be either 65 years of age or older, or have received Social Security Disability Insurance for at least 24 months. For Medicaid eligibility, your income and assets must fall at or below your state's thresholds.
Medicare Special Needs Plan Enrollment Periods
After determining your eligibility for Univera Medicare Dual , it’s important to be aware of the Medicare Enrollment Periods, which determine when you can enroll in or change your plan. Depending on your circumstances, one of the following periods will apply:
- Initial Enrollment Period (IEP): The first time you can enroll in Medicare, typically around your 65th birthday.
- Annual Enrollment Period (AEP): Occurs yearly and allows you to make changes to your Medicare coverage.
- Special Enrollment Periods (SEPs): Special circumstances, such as moving or losing other coverage, may qualify you to enroll outside of the usual periods.
For more details on enrollment periods, you can learn more here and make sure you’re well-informed about your Medicare choices.
Contact Excellus Health Plan Community Care LLC
Call 833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Fri 5am-6pm, Sat 6am-5pm PST) and learn more about this plan and other plans on this site. You may also Enroll Online.
| Contact Type | Details |
|---|---|
| Website: | Excellus Health Plan Community Care LLC Plan Page |
| Providers: | Excellus Health Plan Community Care LLC Providers Page |
| Formulary: | Excellus Health Plan Community Care LLC Formulary Page |
| Pharmacy: | Excellus Health Plan Community Care LLC Pharmacy Page |
| New Member Health Plan Help: | (800)659-1986 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (800)659-1986 |
| New Member Part D TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your status, visit Social Security Administration website or Medicare.gov.
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Excellus Health Plan Community Care LLC Official Plan Details – 2025
Official webpage by Excellus Health Plan Community Care LLC detailing the Aetna Medicare Preferred (HMO D-SNP) plan benefits, coverage, and enrollment options.
Source Webpage: https://www.UniveraMedicare.com -
CMS Medicare Advantage and Prescription Drug Plan Landscape Files – 2025
Official CMS dataset detailing Medicare Advantage and Prescription Drug plans for 2025.
Creator: Centers for Medicare & Medicaid Services
Data Format: ZIP Archive
Coverage Period: January 1, 2025 – December 31, 2025
Download: cy2025-landscape-202412.zip
Source Webpage: CMS Medicare Coverage: Prescription Drug Coverage -
CMS Medicare Star Ratings Data Tables – 2025
Official CMS Star Ratings dataset providing performance ratings for Medicare plans for 2025.
Creator: Centers for Medicare & Medicaid Services
Data Format: ZIP Archive
Coverage Period: January 1, 2025 – December 31, 2025
Download: 2025-star-ratings-data-tables.zip
Source Webpage: CMS Part C and D Performance Data -
CMS Plan Benefits Package (PBP) Files – 2025
Official CMS dataset providing detailed plan benefit information for Medicare Advantage plans in 2025.
Creator: Centers for Medicare & Medicaid Services
Data Format: ZIP Archive
Coverage Period: January 1, 2025 – December 31, 2025
Download: pbp-benefits-2025.zip
Source Webpage: CMS Medicare Advantage and Part D Benefits Data