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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 2025, 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 4 out of 5 stars in 2025.
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 $113.30. 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 $590.00 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:
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Drug Coverage
The Medicare BluePlus (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will pay a $6 copay at preferred pharmacies and a $11 copay at standard pharmacies. For all other tiers, you will pay 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Medicare BluePlus (PPO) plan offers a variety of benefits, including coverage for inpatient hospital stays, outpatient services, and emergency care. Inpatient hospital stays have a copay of $350 for the first 5 days, while outpatient services and partial hospitalization require 20% coinsurance. Emergency services have a $110 copay, and ambulance services have a $250 copay. This plan also covers primary care services with a $15-$40 copay for most services, and some services require coinsurance. Preventive services are covered, as are hearing, vision, and dental services, with varying copays and coinsurance for each. Other covered services include home health, skilled nursing facilities, and diagnostic services, with specific copays and coinsurance detailed in the plan information.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $350 copay for days 1-5 and no copay for days 6-90. For Inpatient Hospital Psychiatric, you pay a $315 copay 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 Inpatient Hospital-Acute are not covered. Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, are covered by this plan with a 20% coinsurance. Ambulatory Surgical Center Services and Outpatient Substance Abuse Services are covered, and individual and group sessions for substance abuse also have a 20% coinsurance. Outpatient Blood Services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered, 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 BluePlus (PPO) plan. Ground and Air Ambulance Services have a $250 copay and 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. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a $250 copay. Worldwide Urgent Coverage has a $40 copay. All services have no coinsurance.
Primary Care See details
The Medicare BluePlus (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy with a $40 copay, physician specialist services with a $40 copay, mental health specialty services with 20% coinsurance, other health care professional services with a $40 copay and 50% coinsurance, psychiatric services with 20% coinsurance, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with 20% coinsurance and a copay between $0 and $40, and opioid treatment program services with 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with prior authorization, annual physical exams, health education, kidney disease education, and additional preventive services like glaucoma screenings and diabetes self-management training. This plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, 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, or counseling services.
Hearing Services See details
Hearing services are covered by the Medicare BluePlus (PPO) plan, including routine hearing exams for a $40 copay, and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with a copay between $499 and $799, while inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams, eyewear, and contact lenses. Routine eye exams are covered once per year. Eyewear, specifically contact lenses, has a $40 copay and a combined maximum benefit of $100 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Medicare BluePlus (PPO) plan covers dental services, including oral exams, dental x-rays, and prophylaxis (cleaning), with a $40 copay for Medicare dental services. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan also covers orthodontic services with a maximum benefit of $1000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Medicare BluePlus (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, but no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, with no copay. Diabetic Supplies have a $5 copay and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests and Lab Services with a $20 copay, Diagnostic Radiological Services and Therapeutic Radiological Services with a 20% coinsurance, and Outpatient X-Ray Services with a $50 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Medicare BluePlus (PPO) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Medicare BluePlus (PPO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medicare BluePlus (PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Under the Medicare BluePlus (PPO) plan, acupuncture is covered with a 50% coinsurance, up to 10 treatments per year. Other services like over-the-counter items, meal benefits, and various other services are not covered.
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