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Medicare BlueEnhanced (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare BlueEnhanced (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medicare BlueEnhanced (PPO) in 2026, please refer to our full plan details page.
Medicare BlueEnhanced (PPO) is a PPO plan offered by Lifetime Healthcare, Inc. available for enrollment in 2025 to people living in Greater Syracuse and Central New York. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Medicare BlueEnhanced (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Medicare BlueEnhanced (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Medicare BlueEnhanced (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $101.30. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $275.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8500.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8500.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Medicare BlueEnhanced (PPO) plan features an annual drug deductible of $275. For Tier 1 preferred generic drugs, members pay no copay when using a preferred pharmacy or preferred mail order, while standard locations require a $5 copay for a one-month supply. Tier 2 generic drugs cost a $5 copay for a one-month supply at preferred pharmacies and mail-order services, or a $10 copay at standard locations. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 5 specialty drugs carry a 29% coinsurance across all pharmacy options. Tier 4 non-preferred drugs cost 36% coinsurance at preferred pharmacies and mail-order services, which increases to 50% coinsurance at standard pharmacies.
Additional Benefits
The Medicare BlueEnhanced (PPO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits and covered preventive services. For specialized care, members pay a $30 copay for specialists and no copay for home health services. Inpatient hospital stays require a $350 daily copay for the first five days and no copay thereafter, while emergency room visits carry a $115 copay that is waived if admitted. This plan also includes dental, vision, and hearing benefits to help manage your everyday health. Covered preventive and comprehensive dental services have no copay up to a $500 annual limit, while routine eye exams also feature no copay. Prescription hearing aids are covered with copays ranging from $499 to $799, and skilled nursing facility stays require no copay for the first 20 days.
Inpatient Hospital See details
Medicare BlueEnhanced (PPO) covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute care days are covered at no copay.
Outpatient Services See details
Medicare BlueEnhanced (PPO) covers outpatient services, featuring a $250 copay and no coinsurance for outpatient hospital and ambulatory surgical center services. Outpatient substance abuse services require no copay but have a 20% coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Medicare BlueEnhanced (PPO) covers partial hospitalization services with no copay and a 20% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Medicare BlueEnhanced (PPO) covers ground and air ambulance services with a $150 copay and no coinsurance, subject to prior authorization. Some transportation services are covered, but transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Medicare BlueEnhanced (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 23 hours, and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency services are also covered with no coinsurance, featuring a $115 copay for emergency care, a $40 copay for urgent care, and a $150 copay for emergency transportation.
Primary Care See details
Medicare BlueEnhanced (PPO) provides primary care physician services with no copay and no coinsurance, while specialist, occupational therapy, and physical therapy visits require a $30 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services feature no copay and 20% coinsurance, whereas podiatry is not covered. Some chiropractic services are covered with a $15 copay and no coinsurance, but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Medicare BlueEnhanced (PPO) with no copay and no coinsurance for covered care such as annual physicals, kidney disease education, glaucoma screenings, and diabetes self-management. However, several supplemental preventive services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety, and counseling.
Hearing Services See details
Hearing services are partially covered by Medicare BlueEnhanced (PPO), which features a $30 copay and no coinsurance for routine hearing exams, and copays ranging from $499 to $799 with no coinsurance for prescription hearing aids. However, over-the-counter hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Medicare BlueEnhanced (PPO) partially covers vision services, offering one annual routine eye exam with no deductible, no copay, and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no deductible, no coinsurance, and a $30 copay for contact lenses up to a $100 annual limit, though eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Medicare BlueEnhanced (PPO), featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for covered preventive and comprehensive services up to a $500 annual limit. Non-covered services include fluoride treatment, implant services, orthodontics, maxillofacial prosthetics, other diagnostic dental, and other preventive dental services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Medicare BlueEnhanced (PPO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Medicare BlueEnhanced (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare BlueEnhanced (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with a $5 copay, and diabetic therapeutic shoes or inserts require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Medicare BlueEnhanced (PPO) partially covers diagnostic and radiological services, though diagnostic procedures, tests, and lab services are not covered. Covered diagnostic services require no copay and no coinsurance, while radiological services feature a $175 copay with no coinsurance for diagnostic radiology, a 20% coinsurance with no copay for therapeutic radiology, and a $40 copay with no coinsurance for outpatient X-rays.
Home Health Services See details
Medicare BlueEnhanced (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Medicare BlueEnhanced (PPO) with no coinsurance, though standard, intensive, and pulmonary rehabilitation, as well as SET for PAD services, are not covered. Covered additional cardiac rehabilitation services require a copayment.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Medicare BlueEnhanced (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. Patients pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Medicare BlueEnhanced (PPO) partially covers Other Services, providing up to 10 acupuncture treatments per year with no copay and 50% coinsurance. Over-the-counter items and meal benefits are not covered.
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