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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 2025, 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 Central New York. This plan received an overall rating of 4 out of 5 stars in 2025.
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 $84.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for preferred and standard generic drugs, and coinsurance for preferred brand and non-preferred drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. You may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Medicare BlueEnhanced (PPO) plan offers comprehensive coverage with a variety of benefits. Inpatient hospital stays have a copay, but outpatient services and home health services have their own copays or coinsurance. Emergency and ambulance services are covered, and primary care, hearing, vision, and dental services are included with copays. This plan also provides coverage for various therapies, including partial hospitalization, dialysis, and cardiac rehabilitation services. There is also coverage for home infusion and medical equipment, as well as diagnostic and radiological services. Several other services are covered, like acupuncture, with varying cost-sharing arrangements.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $260 for days 1-5 and no copay for days 6-90. Additional days for inpatient hospital acute are covered with no copay, while non-Medicare-covered stays and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services, observation services, and ambulatory surgical center services, each with a $200 copay. Outpatient substance abuse services are covered with 20% coinsurance for both individual and group sessions, while outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Medicare BlueEnhanced (PPO) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medicare BlueEnhanced (PPO) plan. Both ground and air ambulance services have a $150 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Medicare BlueEnhanced (PPO) plan. Emergency Services has a $110 copay, and Urgently Needed Services has a $40 copay, while Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $150 copay.
Primary Care See details
The Medicare BlueEnhanced (PPO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Occupational therapy services have a $30 copay, and physician specialist services have a $30 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a 20% coinsurance. Additional telehealth benefits have a $0-$30 copay and a 20% coinsurance. Physical therapy and speech-language pathology services have a $30 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered preventive services, are covered by the Medicare BlueEnhanced (PPO) plan. Additional preventive services, Health Education, Fitness Benefit, Enhanced Disease Management, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered; however, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services are covered by the Medicare BlueEnhanced (PPO) plan, including routine hearing exams for a $30 copay. Prescription hearing aids (all types) are covered with a copay between $499 and $799, and fitting/evaluation for hearing aids is also covered. Prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Medicare BlueEnhanced (PPO) plan covers vision services, including routine eye exams once per year, and eyewear with a $30 copay for contact lenses, but does not cover eyeglass lenses, eyeglass frames, or upgrades. The plan offers a combined maximum benefit of $100 per year for eyewear.
Dental Services See details
Dental services include coverage for oral exams with a $30 copay, up to 2 visits per year, dental x-rays with a $30 copay, up to 2 per year, and prophylaxis (cleaning) with a $30 copay, up to 2 visits per year. Orthodontic services are covered up to a maximum of $1000 per year, and restorative services, adjunctive general services, endodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Medicare BlueEnhanced (PPO) plan, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Medicare BlueEnhanced (PPO) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a $5 copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Medicare BlueEnhanced (PPO) plan covers diagnostic and radiological services, although some services are not covered. Diagnostic Radiological Services have a copay of at most $125, while Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have a copay of $40.
Home Health Services See details
Home Health Services are covered by the Medicare BlueEnhanced (PPO) plan, with no copay or coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Medicare BlueEnhanced (PPO) plan, but the specific copay is not provided in the snippet. However, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, Additional Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medicare BlueEnhanced (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Medicare BlueEnhanced (PPO) plan covers acupuncture with a 50% coinsurance, but only up to 10 treatments every year. Meal benefits for chronic illnesses are also covered. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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