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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 East 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:
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Drug Coverage
Prescription drugs are not covered by Medicare BlueSalute (PPO).
Additional Benefits
The Medicare BlueSalute (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and emergency services with varying copays. Preventive services include coverage for routine exams and screenings, while hearing and vision services are covered with copays and limitations. Dental services include oral exams and cleanings with a $35 copay, but orthodontics is not covered. Additional benefits include ambulance and transportation services, home health services with no copay, and coverage for medical equipment and diagnostic services with copays or coinsurance. The plan also covers some services such as acupuncture and over-the-counter items, while certain services like partial hospitalization, dialysis, and skilled nursing facilities have coinsurance or copays.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will 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 will pay a $324 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services for the Medicare BlueSalute (PPO) plan includes coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Outpatient Hospital Services, Observation Services, and Ambulatory Surgical Center (ASC) Services each have a $300 copay, while Outpatient Substance Abuse Services (individual and group sessions) are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by 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, with a $200 copay for both ground and air ambulance services. Transportation Services to any health-related location are covered for up to 12 one-way trips per year.
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, Urgently Needed Services have a $40 copay, and Worldwide Emergency Services have different copays depending on the specific service, with Worldwide Emergency Coverage having a $110 copay, Worldwide Urgent Coverage having a $40 copay, and Worldwide Emergency Transportation having a $200 copay.
Primary Care See details
The Medicare BlueSalute (PPO) plan covers primary care physician services and chiropractic services with a $5 copay. Occupational therapy, physician specialist services, and physical therapy services have a $35 copay. Other health care professionals and opioid treatment program services have 50% and 20% coinsurance, respectively, while additional telehealth benefits have a 20% coinsurance and a copay between $0 and $35. Mental health and psychiatric services are partially covered, as individual and group sessions are not covered. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, Annual Physical Exams, Health Education, Fitness Benefits, Enhanced Disease Management, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit. The plan does not cover 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, or Counseling Services.
Hearing Services See details
Hearing exams are covered with a $35 copay, including routine hearing exams once per year and fitting/evaluation for hearing aids, which is unlimited. Prescription hearing aids are covered with a copay between $499 and $799 for all types of prescription hearing aids, up to two per year, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Medicare BlueSalute (PPO) plan covers vision services, including routine eye exams once per year, and eyewear with a $35 copay for contact lenses. Eyeglasses (lenses and frames) and contact lenses are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered. There is a combined maximum benefit of $250 per year for all eyewear, applicable to both in-network and out-of-network services.
Dental Services See details
The Medicare BlueSalute (PPO) plan covers dental services, including oral exams, dental x-rays, and prophylaxis (cleaning), with a $35 copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services have a $1,000 annual maximum benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Medicare BlueSalute (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 under the Medicare BlueSalute (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies (non-Medicare), and Diabetic Equipment, is covered. DME has a 20% coinsurance with prior authorization required, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. 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, including Diagnostic Procedures/Tests and Lab Services, are covered by the Medicare BlueSalute (PPO) plan, with a $15 copay for Diagnostic Procedures/Tests and Lab Services. Diagnostic Radiological Services have a maximum copay of $150, while Therapeutic Radiological Services have a 20% coinsurance, 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, but authorization is required. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by the Medicare BlueSalute (PPO) plan, with a copay required for some services. However, 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 Medicare BlueSalute (PPO), but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Medicare BlueSalute (PPO) plan covers acupuncture with a 50% coinsurance, and over-the-counter items, with a maximum benefit of $50 every three months. Additionally, the plan offers a meal benefit for chronic illnesses, and some other services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more.
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