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Medicare BluePlus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare BluePlus (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medicare BluePlus (PPO) in 2026, please refer to our full plan details page.
Medicare BluePlus (PPO) is a PPO plan offered by Lifetime Healthcare, Inc. available for enrollment in 2025 to people living in East New York. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Medicare BluePlus (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 BluePlus (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 BluePlus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $140.00. 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 a $615.00 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 $9300.00 (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 $9300.00 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:
Sign up for Medicare BluePlus (PPO)
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Drug Coverage
The Medicare BluePlus (PPO) plan features an annual drug deductible of $615 before coverage begins. For Tier 1 preferred generic drugs, you will pay a low copay of $4 for a one-month supply at preferred pharmacies and mail-order services, or $9 at standard pharmacies. Tier 2 generic medications cost a $7 copay per month at preferred locations and an $11 copay at standard pharmacies and mail order. For higher-tier prescriptions, this plan utilizes coinsurance instead of flat copays during the initial coverage phase. Tier 3 preferred brand drugs require a 21% coinsurance at preferred locations and 25% at standard locations. Non-preferred drugs in Tier 4 and specialty drugs in Tier 5 both carry a flat 25% coinsurance across all pharmacy and mail-order options.
Additional Benefits
Medicare BluePlus (PPO) provides robust coverage for essential medical services with clear, predictable costs. Inpatient hospital stays require a $425 copay for days 1 to 5, with no copay for day 6 and beyond. Primary care doctor visits are highly affordable at a $5 copay, while specialist visits carry a $40 copay and emergency room visits have a $115 copay. Preventive care and home health services are fully covered with no copay or coinsurance. Routine vision exams also feature no copay, while covered dental services have no copay up to a $500 annual limit. Routine hearing exams require a $40 copay, and skilled nursing facility stays have no copay for the first 20 days.
Inpatient Hospital See details
Medicare BluePlus (PPO) covers inpatient acute hospital stays with no coinsurance and a $425 copay for days 1 to 5, with no copay for day 6 and beyond. Inpatient psychiatric care is also covered with no coinsurance and a $315 copay for days 1 to 5, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Medicare BluePlus (PPO) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay and no coinsurance, and there is no deductible.
Partial Hospitalization See details
Medicare BluePlus (PPO) covers partial hospitalization services with no copay and a 20% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services under Medicare BluePlus (PPO) are partially covered, offering Medicare-approved ground and air ambulance services with a $250 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered.
Emergency Services See details
Medicare BluePlus (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 23 hours. Urgently needed services have a $40 copay with no coinsurance, and worldwide coverage is available with no coinsurance and copays of $115 for emergency care, $40 for urgent care, and $250 for emergency transportation.
Primary Care See details
Medicare BluePlus (PPO) covers primary care doctor visits for a $5 copay and specialist visits for a $40 copay, both with no coinsurance. Physical and occupational therapy services require a $35 copay with no coinsurance, while mental health and psychiatric sessions have no copay and a 20% coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by Medicare BluePlus (PPO) with no copay and no coinsurance. Uncovered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for chemotherapy-related hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional and dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Medicare BluePlus (PPO) hearing services are partially covered, offering routine hearing exams for a $40 copay and no coinsurance, with no deductible. Up to two prescription hearing aids per year are covered with a copay ranging from $499.00 to $799.00 and no coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Medicare BluePlus (PPO) vision services are partially covered with no deductibles, offering one routine eye exam per year with no copay or coinsurance. Eyewear is covered up to a $100 annual limit with no coinsurance and a $40 copay for contact lenses, though other eye exams, eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Medicare BluePlus (PPO) dental services are partially covered, offering Medicare-covered dental care for a $40 copay and no coinsurance, and other covered dental services with no copay and no coinsurance up to a $500 annual limit. Services not covered under this plan include fluoride treatments, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive dental services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Medicare BluePlus (PPO) with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Medicare BluePlus (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Medicare BluePlus (PPO), with durable medical equipment, prosthetics, and medical supplies requiring no copay and 20% coinsurance. Diabetic supplies from specified manufacturers are covered with a $5 copay and no coinsurance, while diabetic therapeutic shoes and inserts require no copay and 20% coinsurance.
Diagnostic and Radiological Services See details
Medicare BluePlus (PPO) covers diagnostic and radiological services with prior authorization required, offering diagnostic procedures, tests, and lab services for a $20 copay and no coinsurance. Outpatient X-rays require a $50 copay and coinsurance, while diagnostic and therapeutic radiological services carry a 20% coinsurance, with diagnostic radiological services also subject to a copay.
Home Health Services See details
Home health services are covered under the Medicare BluePlus (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered under Medicare BluePlus (PPO), requiring a $15 copay and no coinsurance for covered services. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Medicare BluePlus (PPO) with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services under the Medicare BluePlus (PPO) plan are partially covered, offering acupuncture with no copay and a 50% coinsurance for up to 10 treatments per year. Supplemental benefits such as over-the-counter (OTC) items and meal benefits are not covered.
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