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Trinity Health Plan New York Glory No RX (HMO) Medicare Advantage Plan H9827-003 • 2027

CMS Rating: ☆☆☆☆☆ (3.0 out of 5 stars*)
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$6300.00In-network
Part B Giveback
−$60.00 reduction
Prescription Coverage
Not Included
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
13 beneficiaries
Last update:

Trinity Health Plan New York Glory No RX (HMO) Introduction

This Medicare Advantage HMO plan, Trinity Health Plan New York Glory No RX, is offered by Trinity Health Plan New York and uses a Health Maintenance Organization (HMO) provider network. It comes without prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $6300.00. The plan is identified by CMS Plan ID H9827-003.

Plan Benefits

Cost-sharing for Trinity Health Plan New York Glory No RX includes out-of-pocket expenses for covered healthcare services. The following tables provide a summary of typical in-network out-of-pocket costs for plan H9827-003.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay In-network: $0 copay
Specialist In-network: $25 copay In-network: $25 copay

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam In-network: $0 copay In-network: $0 copay
Telehealth benefit In-network: $0-$25 copay In-network: $0-$25 copay
Routine chiropractic Not covered Not covered
Fitness benefits Coming soon In-network: $0 copay
Health education Not covered Not covered
Counseling services Not covered Not covered
Over-the-counter drug benefits In-network: $0 copay In-network: $0 copay
Health transportation (non-emergency) Coming soon Not covered

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $295 copay In-network: $275 copay
Lab services In-network: $0 copay In-network: $0 copay
Outpatient x-rays In-network: $35 copay In-network: $35 copay
Diagnostic tests and procedures In-network: $25 copay In-network: $25 copay

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $130 copay $130 copay
Worldwide emergency care Coming soon $130 copay
Urgent care $50 copay $50 copay
Inpatient hospital care Tier 1
$395 per day for days 1-5
$0 per day for days 6-90
$0 per stay		 Tier 1
$375 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Skilled Nursing Facility Tier 1
$0 per day for days 1-20
$221 per day for days 21-65
$0 per day for days 66-100		 Tier 1
$0 per day for days 1-20
$218 per day for days 21-60
$0 per day for days 61-100
Ground ambulance In-network: $200 copay In-network: $150 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $25 copay In-network: $25 copay
Outpatient group therapy In-network: $25 copay In-network: $25 copay
Inpatient psychiatric hospital care Tier 1
$395 per day for days 1-5
$0 per day for days 6-90
$0 per stay		 Tier 1
$375 per day for days 1-5
$0 per day for days 6-90
$0 per stay

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $25 copay In-network: $25 copay
Occupational therapy In-network: $25 copay In-network: $25 copay

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: $0 copay In-network: $0 copay
Durable medical equipment In-network: 20% coinsurance In-network: 20% coinsurance
Prosthetics In-network: 20% coinsurance In-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered) In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay In-network: $0 copay
Dental x-rays In-network: $0 copay In-network: $0 copay
Cleaning In-network: $0 copay In-network: $0 copay
Periodontics In-network: 70% coinsurance In-network: 70% coinsurance
Endodontics In-network: 70% coinsurance In-network: 70% coinsurance
Restorative services In-network: 50% coinsurance In-network: 50% coinsurance
Implant services Not covered Not covered
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery In-network: 50% coinsurance In-network: 50% coinsurance

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $0 copay In-network: $0 copay
Contact lenses In-network: $0 copay In-network: $0 copay
Eyeglass frames only In-network: $0 copay In-network: $0 copay
Eyeglass lenses only In-network: $0 copay In-network: $0 copay
Eyeglasses (frames & lenses) In-network: $0 copay In-network: $0 copay
Upgrades Not covered Not covered

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay In-network: $0 copay
Fitting/evaluation In-network: $0 copay In-network: $0 copay
Prescription hearing aids In-network: $399-$699 copay In-network: $399-$699 copay
OTC hearing aids Not covered Not covered

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Not covered
Home-based palliative care Not covered Not covered
Personal emergency response system Coming soon Not covered
Weight management programs Not covered Not covered
Wigs for chemotherapy-related hair loss Coming soon Not covered
Alternative therapies Not covered Not covered
Massage therapy Not covered Not covered
Home/bathroom safety devices Not covered Not covered

Certain preventive services are covered 100% by Trinity Health Plan New York Glory No RX as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

CMS 5-Star Performance Ratings (Contract ID: H9827)

CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.

2027 Medicare Star Ratings for Contract H9827
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines Not enough data available
Managing Chronic (Long Term) Conditions Not enough data available
Member Experience with Health Plan Not enough data available
Complaints and Changes in Plans Performance Not enough data available
Health Plan Customer Service Not enough data available
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan Not enough data available
Member Experience with the Drug Plan Not enough data available
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆

Contact Information for Trinity Health Plan New York

Website
Trinity Health Plan New York Plan Page
Providers
Trinity Health Plan New York Providers Page
Formulary
Trinity Health Plan New York Formulary Page
Pharmacy
Trinity Health Plan New York Pharmacy Page
New Member Health Plan Help
(800)964-4525
New Member Health Plan TTY
711

Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.

Frequently Asked Questions

Here are some of the most frequently asked questions about this plan (click to open).

Frequently Asked Questions About Trinity Health Plan New York Glory No RX (HMO)

What is the monthly premium for Trinity Health Plan New York Glory No RX (HMO)?

The 2027 monthly premium is $0.00. The Medicare Part B premium is paid separately.

What is the in-network MOOP for plan H9827-003?

For 2027, the in-network maximum out-of-pocket is $6300.00. The plan pays 100% of covered in-network services beyond this amount.

What is the total enrollment for plan H9827-003?

Total enrollment is 13 beneficiaries based on the latest CMS data.

What is the Part D deductible for plan H9827-003?

The plan’s Part D deductible is $0.00, applied to covered prescription drug costs.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Trinity Health Plan New York (official source) http://www.thpmedicare.org/new-york October 4, 2026
CMS.gov Medicare Advantage Plan Fact Sheet 25 May, 2025
AARP.org The Big Choice: Original Medicare vs. Medicare Advantage 25 May, 2025
Medicare.gov Your coverage options 25 May, 2025

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Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.