Senior Whole Health of New York NHC (HMO D-SNP) Medicare Special Need Plan H5992-007 • 2027
- Monthly Premium
- $21.40Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 911 beneficiaries
Introduction
Senior Whole Health of New York NHC is a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) offered by Senior Whole Health of New York. The plan uses a Health Maintenance Organization (HMO) provider network and includes Medicare Part D prescription drug coverage. For the 2027 plan year, it has a $21.40 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. CMS Plan ID H5992-007 identifies this plan. The 2027 Part D prescription drug deductible is $700.00.
CMS reports 911 beneficiaries enrolled across all service areas. You must live in the plan's service area to enroll: See List.
Eligibility
Senior Whole Health of New York NHC is a Medicare D-SNP plan for people who qualify for both Medicare and Medicaid.
- Special Needs Plan Type
- Dual-Eligible Special Needs Plan (D-SNP)
- Medicare Requirement
- Medicare Part A and Part B
- Special Needs Requirement
- Must qualify for Medicaid
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Plan Benefits
Senior Whole Health of New York NHC has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H5992-007.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Specialist | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | Not covered | Not covered |
| Telehealth benefit | In-network: $0 copay | In-network: $0 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay |
| Health education | In-network: $0 copay | In-network: $0 copay |
| 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 | In-network: $0 copay |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Lab services | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Outpatient x-rays | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Diagnostic tests and procedures | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $0 copay | $0 copay |
| Worldwide emergency care | Coming soon | $0 copay |
| Urgent care | $0 copay | $0 copay |
| Inpatient hospital care | Tier 1 $0 per stay |
Tier 1 $0 per day for days 1-60 $0 per day for days 61-90 $0 per day for days 91-150 |
| Skilled Nursing Facility | Tier 1 $0 per day for days 1-20 $0 per day for days 21-100 |
Tier 1 $0 per day for days 1-20 $209.5 per day for days 21-100 |
| Ground ambulance | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Outpatient group therapy | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Inpatient psychiatric hospital care | Tier 1 $0 per stay |
Tier 1 $0 per day for days 1-60 $0 per day for days 61-90 $0 per day for days 91-150 |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Occupational therapy | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Durable medical equipment | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Prosthetics | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Other Part B drugs (Medicare-covered) | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
Dental Services
| 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: $0 copay | In-network: $0 copay |
| Endodontics | In-network: $0 copay | In-network: $0 copay |
| Restorative services | In-network: $0 copay | In-network: $0 copay |
| Implant services | In-network: $0 copay | In-network: $0 copay |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $0 copay | In-network: $0 copay |
Vision Services
| 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 | In-network: $0 copay | In-network: $0 copay |
Hearing Services
| 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: $0 copay | In-network: $0 copay |
| OTC hearing aids | In-network: $0 copay | In-network: $0 copay |
Additional and Special Needs Services
| 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 Senior Whole Health of New York NHC as a Part B benefit.
Prescription Drug Coverage
Senior Whole Health of New York NHC includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $21.40 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $21.40 |
| Low-Income Premium Subsidy: | $40.45 |
| Low-Income Premium Subsidy Paid by CMS: | $21.40 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Senior Whole Health of New York starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Senior Whole Health of New York NHC may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | $0.00 copay |
| Generic | 25% coinsurance | 20% coinsurance |
| Preferred Brand | 25% coinsurance | 20% coinsurance |
| Non-Preferred Drug | 26% coinsurance | 30% coinsurance |
| Specialty Tier | 25% coinsurance | 25% coinsurance |
| Select Care Drugs | $0.00 copay | $0.00 copay |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H5992)
CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
| Managing Chronic (Long Term) Conditions | |
| 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 Senior Whole Health of New York
- Website
- Senior Whole Health of New York Plan Page
- Providers
- Senior Whole Health of New York Providers Page
- Formulary
- Senior Whole Health of New York Formulary Page
- Pharmacy
- Senior Whole Health of New York Pharmacy Page
- New Member Health Plan Help
- (844)245-9281
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (844)245-9281
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Senior Whole Health of New York NHC (H5992-007-0) is available in the following locations (click to open):
Medicare Plan Data Sources and Methodology
| 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.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Senior Whole Health of New York (official source) | http://www.SWHNY.com | October 4, 2026 |
| CMS.gov | Dual Eligible Special Needs Plans (D-SNPs) | April 28, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | April 28, 2026 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | April 28, 2026 |
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