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Univera SeniorChoice Access (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Univera SeniorChoice Access (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Univera SeniorChoice Access (PPO) in 2025, please refer to our full plan details page.
Univera SeniorChoice Access (PPO) is a PPO plan offered by Lifetime Healthcare, Inc. available for enrollment in 2025 to people living in Western New York. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Univera SeniorChoice Access (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 Univera SeniorChoice Access (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 Univera SeniorChoice Access (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.90. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $350.00 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 $11700.00 (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 $11700.00 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 Univera SeniorChoice Access (PPO)
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Drug Coverage
The Univera SeniorChoice Access (PPO) plan has a $350 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $12 copay at a preferred pharmacy. For preferred brand drugs, you'll pay 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Univera SeniorChoice Access (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, with no copay after the fifth day. Outpatient services have a $300 copay, while primary care visits, including specialist and mental health services, have copays or coinsurance. This plan also includes coverage for emergency services, preventive services with no copay, hearing and vision services with copays, and dental services with a $35 copay. Additional benefits include home health services with no copay, dialysis services with 20% coinsurance, and medical equipment with 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $375 copay for days 1-5, and no copay for days 6-90, while for Inpatient Hospital Psychiatric, you pay a $315 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and ambulatory surgical center services, are covered with a $300 copay. Outpatient substance abuse services are covered with 20% coinsurance for both individual and group sessions. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Univera SeniorChoice Access (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 Univera SeniorChoice Access (PPO) plan. Medicare-covered Ground and Air Ambulance Services have a $325 copay, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Univera SeniorChoice Access (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $325 copay; all services have no coinsurance.
Primary Care See details
The Univera SeniorChoice Access (PPO) plan covers primary care physician services, chiropractic services with a $5 copay, occupational therapy services with a $35 copay, and physician specialist services with a $35 copay. Mental health specialty services and psychiatric services have a 20% coinsurance for individual and group sessions, and physical therapy and speech-language pathology services have a $35 copay. Other health care professionals have a 50% coinsurance with a $35 copay, and additional telehealth benefits have a 20% coinsurance with a $0-$35 copay. Opioid treatment program services have a 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Univera SeniorChoice Access (PPO) plan covers preventive services, including Medicare-covered services with prior authorization, annual physical exams, health education, fitness benefits (Memory Fitness), enhanced disease management, Kidney Disease Education Services, and other preventive services like glaucoma screening and diabetes self-management training, with no copay or coinsurance. In-home safety assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), and several other services are not covered.
Hearing Services See details
Hearing Services include Routine Hearing Exams with a $35 copay, Fitting/Evaluation for Hearing Aid, and Prescription Hearing Aids (all types) with a copay between $499 and $799. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include coverage for routine eye exams, and eyewear. Routine eye exams are covered once per year. Eyewear, including contact lenses, are covered with a $35 copay, with a combined maximum benefit of $250 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Univera SeniorChoice Access (PPO) plan covers dental services, including oral exams, dental x-rays, and cleaning with a $35 copay for Medicare dental services. Orthodontic services are covered up to a maximum of $1000 per year. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
The Univera SeniorChoice Access (PPO) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Univera SeniorChoice Access (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies - Non-Medicare benefits with coinsurance. Diabetic Equipment is covered, with a copay of $5 for Diabetic Supplies and 20% coinsurance for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Univera SeniorChoice Access (PPO) plan. Diagnostic Procedures/Tests and Lab Services are not covered, while Diagnostic Radiological Services have a copay of $300, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $60 copay.
Home Health Services See details
Home Health Services are covered by the Univera SeniorChoice Access (PPO) plan with no copay and no coinsurance, but 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 Univera SeniorChoice Access (PPO) plan. However, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Univera SeniorChoice Access (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day, with no coinsurance.
Other Services See details
Other Services includes coverage for acupuncture with a 50% coinsurance, up to 10 treatments per year. Other services such as Over-the-Counter (OTC) Items, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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