A non-government entity
Medicare BlueActive (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare BlueActive (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medicare BlueActive (PPO) in 2026, please refer to our full plan details page.
Medicare BlueActive (PPO) is a PPO plan offered by Lifetime Healthcare, Inc. available for enrollment in 2025 to people living in Greater Syracuse Region. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Medicare BlueActive (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 BlueActive (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 BlueActive (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 $38.80. 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.
This plan has a $615.00 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 $11300.00 (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 $11300.00 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 BlueActive (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
The Medicare BlueActive (PPO) plan features an annual drug deductible of $615 before coverage begins. For Tier 1 preferred generic drugs, you will pay a low copayment starting at $6 for a 1-month supply at preferred pharmacies and preferred mail-order services, or $11 at standard pharmacies. Tier 2 generic drugs are also highly affordable, with 1-month copayments ranging from $15 at preferred locations to $20 at standard locations. For higher-tier medications, costs shift to coinsurance, with Tier 3 preferred brand drugs requiring a 21% coinsurance at preferred pharmacies and 25% at standard pharmacies. Tier 4 non-preferred drugs carry a 25% coinsurance at preferred pharmacies and a 50% coinsurance at standard pharmacies. Specialty medications in Tier 5 consistently require a 25% coinsurance across all pharmacy and mail-order options.
Additional Benefits
Medicare BlueActive (PPO) offers comprehensive coverage for essential medical needs, featuring a $10 copay for primary care visits and a $45 copay for specialists with no coinsurance. Inpatient hospital stays require a $440 daily copay for the first five days and no copay thereafter, while outpatient hospital services carry a $375 copay. Emergency care is accessible with a $115 copay, and skilled nursing facility stays feature no copay for the first 20 days. The plan also provides valuable supplemental benefits, including preventive dental care and routine eye exams with no copay and no coinsurance. Routine hearing exams are available for a $45 copay, with prescription hearing aids covered at copays ranging from $499 to $799. Additionally, diagnostic lab tests require a $15 copay, while durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Medicare BlueActive (PPO) with no coinsurance and prior authorization required. Acute stays require a $440 daily copay for days 1-5 (no copay thereafter), and psychiatric stays require a $405 daily copay for days 1-5 (no copay for days 6-90), but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Medicare BlueActive (PPO) covers outpatient hospital and ambulatory surgical center services with a $375 copay and no coinsurance. Outpatient substance abuse services require a 20% coinsurance with no copay, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Medicare BlueActive (PPO) covers partial hospitalization services with no copay and a 20% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Medicare BlueActive (PPO) covers ground and air ambulance services with a $300 copay and no coinsurance, although prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Medicare BlueActive (PPO) covers emergency services with a $115 copay (waived if admitted to the hospital within 23 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $115, $40, and $300 respectively.
Primary Care See details
Medicare BlueActive (PPO) offers partially covered primary care benefits, as podiatry, routine chiropractic, and other chiropractic services are not covered. Covered services include primary care visits for a $10 copay and no coinsurance, specialist visits for a $45 copay and no coinsurance, occupational and physical therapy for a $35 copay and no coinsurance, and mental health, psychiatric, or opioid treatment services for no copay and 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered by Medicare BlueActive (PPO) with no copay and no coinsurance for covered services like annual physicals, kidney disease education, and memory fitness. However, the plan does not cover health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Medicare BlueActive (PPO) covers hearing services, including one routine hearing exam per year for a $45 copay and no coinsurance, as well as unlimited hearing aid fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $499 to $799 for up to two aids per year, though OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Medicare BlueActive (PPO) partially covers vision services, offering one routine eye exam per year with no copay and no coinsurance, while other eye exams are not covered. Eyewear is also partially covered with a $45 copay for contact lenses, no coinsurance, and a $100 annual maximum benefit, though eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are covered by Medicare BlueActive (PPO) with no copay and no coinsurance for preventive and most comprehensive care, while Medicare-covered dental services require a $45 copay and no coinsurance. Comprehensive services have a $500 annual limit, but fluoride treatments, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive dental services are not covered.
Home Infusion bundled Services See details
Medicare BlueActive (PPO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B insulin requires a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Medicare BlueActive (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare BlueActive (PPO) covers medical equipment, offering durable medical equipment and prosthetics with no copay and a 20% coinsurance. Diabetic supplies are covered with a $5 copay, while diabetic therapeutic shoes and inserts carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Medicare BlueActive (PPO) with prior authorization required, featuring a $15 copay and no coinsurance for diagnostic procedures, tests, and lab services. Radiological services require a $60 copay for X-rays, a minimum $300 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Medicare BlueActive (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Medicare BlueActive (PPO) offers partial coverage for Cardiac Rehabilitation Services with no coinsurance, although standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. Covered additional cardiac rehabilitation services require a $15 copayment and no coinsurance.
Skilled Nursing Facility (SNF) See details
Medicare BlueActive (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, but additional days beyond the standard 100-day limit are not covered.
Other Services See details
Medicare BlueActive (PPO) partially covers other services, providing acupuncture with no copay and a 50% coinsurance for up to 10 treatments per year. Over-the-counter (OTC) items and meal benefits are not covered under this benefit.
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