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 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 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 affordable coverage for core medical needs, featuring a $5 copay for primary care visits, a $35 copay for specialists, and no copay for annual physical exams. Inpatient acute hospital stays require a $325 copay for days 1 through 5, while outpatient hospital services carry a $300 copay, both with no coinsurance. Emergency care is available for a $115 copay, which is waived upon admission, while urgently needed services require a $40 copay. Routine vision exams and select dental services are covered with no copay, while routine hearing exams require a $35 copay. Durable medical equipment, prosthetics, and dialysis services are covered with no copay and a 20% coinsurance. Additionally, members benefit from up to 12 one-way transportation trips per year and a $30 quarterly over-the-counter allowance with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by Medicare BlueSalute (PPO) with no coinsurance, requiring a $325 copay for days 1 to 5 of acute stays and a $324 copay for days 1 to 5 of psychiatric stays, with no copay for days 6 to 90. Unlimited additional acute days are covered at no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Medicare BlueSalute (PPO) covers outpatient hospital and ambulatory surgical center services for a $300 copay and no coinsurance, and outpatient blood services with no copay and no coinsurance. Some outpatient substance abuse services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered under the Medicare BlueSalute (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Medicare BlueSalute (PPO), requiring a $200 copay and no coinsurance for ground and air ambulance services. The plan also covers up to 12 one-way transportation trips per year to any health-related location with no copay and no coinsurance.
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) offers primary care visits for a $5 copay and no coinsurance, and specialist, occupational, and physical therapy services for a $35 copay and no coinsurance. Podiatry is not covered, and while some chiropractic, mental health, and psychiatric services are covered, routine chiropractic care, other chiropractic services, and individual and group sessions for mental health and psychiatry are not.
Preventive Services See details
Preventive services are covered by Medicare BlueSalute (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and screenings. This benefit is partially covered, as it excludes health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling services.
Hearing Services See details
Medicare BlueSalute (PPO) covers routine hearing exams with a $35 copay and no coinsurance, and hearing aid fittings with no copay or coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay between $499 and $799 for up to two devices annually, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Medicare BlueSalute (PPO) provides partially covered vision services with no deductible, featuring one annual routine eye exam with no copay and no coinsurance. Eyewear is covered with no coinsurance and a $35 copay for contact lenses up to a combined $200 annual limit, though other eye exams, 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 with a $35 copay and no coinsurance, and other covered dental services with no copay and no coinsurance. While select preventive, restorative, and surgical services are covered, fluoride treatments, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Medicare BlueSalute (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Medicare BlueSalute (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare BlueSalute (PPO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies from specified manufacturers are covered with a $5 copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Medicare BlueSalute (PPO) covers diagnostic and radiological services, requiring prior authorization for both. Diagnostic procedures and lab services have a $15 copay and no coinsurance, while outpatient X-rays require a $40 copay, diagnostic radiological services have a $150 copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Medicare BlueSalute (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered in part by Medicare BlueSalute (PPO) with no copay and no coinsurance, though standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Medicare BlueSalute (PPO) covers skilled nursing facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a three-day prior inpatient hospital stay is not required for admission, additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Medicare BlueSalute (PPO) partially covers other services, including up to 10 acupuncture treatments per year with no copay and 50% coinsurance. Chronic illness meals and a $30 quarterly over-the-counter allowance are also covered with no copay and no coinsurance, while 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