A non-government entity
Medicare BlueSalute (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare BlueSalute (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medicare BlueSalute (PPO) in 2026, please refer to our full plan details page.
Medicare BlueSalute (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 BlueSalute (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Medicare BlueSalute (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 BlueSalute (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $35.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $7800.00 (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 $7800.00 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 BlueSalute (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by Medicare BlueSalute (PPO).
Additional Benefits
Medicare BlueSalute (PPO) offers comprehensive medical coverage with predictable out-of-pocket costs, featuring a $5 copay for primary care visits and a $35 copay for specialist visits with no coinsurance. Inpatient hospital stays require a daily copay of up to $325 for the first five days and no copay for subsequent days, while emergency room visits carry a $115 copay that is waived if admitted. Outpatient hospital services are covered with a $300 copay and no coinsurance, ensuring affordable access to essential medical procedures. This plan also provides excellent value on routine care, offering preventive services, annual routine eye exams, and select dental care with no copay and no coinsurance. Vision hardware is covered up to a $200 annual limit, and routine hearing exams are available for a $35 copay, with prescription hearing aids requiring copays between $499 and $799. Additionally, members benefit from no copay on home health services and up to 12 one-way transportation trips per year to health-related locations.
Inpatient Hospital See details
Medicare BlueSalute (PPO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $325 for days 1-5 of acute stays (no copay for days 6 and beyond) and $324 for days 1-5 of psychiatric stays (no copay for days 6-90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Medicare BlueSalute (PPO) covers outpatient hospital, observation, and ambulatory surgical center services with a $300 copay and no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible. Outpatient substance abuse services are not covered under this plan because both individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization services are covered under Medicare BlueSalute (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Medicare BlueSalute (PPO) covers ground and air ambulance services with a $200 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 12 one-way trips per year to any health-related location, but transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Medicare BlueSalute (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 require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $115, $40, and $200 respectively.
Primary Care See details
Medicare BlueSalute (PPO) covers primary care visits for a $5 copay and specialist, occupational, and physical therapy services for a $35 copay, all with no coinsurance. Other healthcare professionals require a $35 copay and 50% coinsurance, telehealth ranges from no copay to a $35 copay with 20% coinsurance, and opioid treatment has no copay and 20% coinsurance. Chiropractic, podiatry, mental health, and psychiatric services are not covered.
Preventive Services See details
Medicare BlueSalute (PPO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. While memory fitness and remote access technologies are covered, other additional preventive services—such as health education, in-home safety assessments, nutritional therapy, and weight management programs—are not covered.
Hearing Services See details
Medicare BlueSalute (PPO) partially covers hearing services, including one annual routine hearing exam for a $35 copay and no coinsurance, alongside unlimited fitting evaluations. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $499 to $799, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Medicare BlueSalute (PPO) partially covers vision services, offering one routine eye exam annually with no copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered up to a $200 annual combined limit with no coinsurance and a $35 copay for contact lenses, but separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Medicare BlueSalute (PPO) partially covers dental services, offering Medicare-covered dental care for a $35 copay and no coinsurance, and other covered preventive and comprehensive services with no copay and no coinsurance. However, some services are not covered, including other diagnostic services, fluoride treatment, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Medicare BlueSalute (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Medicare BlueSalute (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare BlueSalute (PPO) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts with no copay and a 20% coinsurance. Diabetic supplies are covered with a $5 copay and no coinsurance, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Medicare BlueSalute (PPO) covers diagnostic and radiological services, with prior authorization required for all services. Diagnostic tests and lab services require a $15 copay and no coinsurance, while radiological services require a $40 copay and no coinsurance for X-rays, a $150 minimum copay and no coinsurance for diagnostic radiology, and a 20% minimum coinsurance with no copay for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under Medicare BlueSalute (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Medicare BlueSalute (PPO) covers some Cardiac Rehabilitation Services with no coinsurance, though specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Medicare BlueSalute (PPO) covers skilled nursing facility (SNF) care with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Other Services are partially covered by Medicare BlueSalute (PPO), offering acupuncture with no copay and 50% coinsurance for up to 10 treatments per year, alongside over-the-counter items (up to $30 every three months) and chronic illness meal benefits with no copay and no coinsurance. Highly integrated services for dual eligible SNPs and other unspecified services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved