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 2025, 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 Central New York. This plan received an overall rating of 4 out of 5 stars in 2025.
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
The Medicare BlueSalute (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services with varying copays. You'll have a $325 copay for days 1-5 of inpatient hospital stays, and $300 copay for outpatient services. The plan covers ambulance and transportation services, emergency services, and primary care with copays ranging from $5 to $200. Additional benefits include preventive services, hearing and vision care, and dental services, each with specific copays for exams and services. The plan also covers home health services with no copay, along with services like home infusion and dialysis with coinsurance requirements. Other benefits include medical equipment, diagnostic and radiological services, and skilled nursing facility stays.
Inpatient Hospital See details
The Medicare BlueSalute (PPO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $325 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you'll pay a $324 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient hospital services, observation services, and ambulatory surgical center services have a $300 copay, while outpatient blood services have a waived three-pint deductible. Outpatient substance abuse services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Medicare BlueSalute (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 BlueSalute (PPO) plan. Ground and Air Ambulance Services have a $200 copay, and there is no coinsurance. Transportation Services to any health-related location are covered for 12 one-way trips per year, with no coinsurance or copay.
Emergency Services See details
Emergency services, urgently needed services, and worldwide emergency services are covered by the Medicare BlueSalute (PPO) plan. Emergency services have a $110 copay, and urgently needed services have a $40 copay, both with no coinsurance; Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $200 copay, all with no coinsurance.
Primary Care See details
The Medicare BlueSalute (PPO) plan covers primary care physician services and chiropractic services for a $5 copay, and physician specialist services and physical therapy for a $35 copay. Occupational therapy services have a $35 copay with no coinsurance, and Other Health Care Professional services and Opioid Treatment Program Services have a 50% and 20% coinsurance, respectively. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $35, and Routine Chiropractic Care and Individual and Group Sessions for Mental Health and Psychiatric Services are not covered.
Preventive Services See details
Preventive services, including Medicare-covered services, annual physical exams, additional preventive services, kidney disease education services, and other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered. Health education, fitness benefits, enhanced disease management, and remote access technologies are also covered. In-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 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, and counseling services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $35 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) have a copay between $499 and $799, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include routine eye exams, with one exam covered every year, and eyewear benefits. Eyewear has a $35 copay for contact lenses, and a combined maximum of $250 per year for both in-network and out-of-network services. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Medicare BlueSalute (PPO) plan covers dental services, including oral exams, dental X-rays, and prophylaxis (cleaning), each with a $35 copay and limited to two visits per year. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services have a $1,000 maximum benefit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Medicare BlueSalute (PPO), with prior authorization required. 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 under the Medicare BlueSalute (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and prior authorization required, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered devices and supplies, and Diabetic Equipment. The plan covers Diabetic Supplies with a $5 copay, Diabetic Therapeutic Shoes/Inserts with 20% coinsurance, and other Diabetic Equipment.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered. Diagnostic Procedures/Tests and Lab Services have a $15 copay, while Diagnostic Radiological Services have a $150 copay, and Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the Medicare BlueSalute (PPO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Medicare BlueSalute (PPO) plan. However, 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 BlueSalute (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Under the Medicare BlueSalute (PPO) plan, acupuncture is covered with a 50% coinsurance, up to 10 treatments per year. Over-the-counter (OTC) items are covered, with a maximum benefit of $50 every three months, and the plan offers nicotine replacement therapy as a Part C OTC benefit. Meal benefits are covered for chronic illnesses. However, services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and many others 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