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Medicare BlueFlex (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare BlueFlex (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medicare BlueFlex (PPO) in 2025, please refer to our full plan details page.
Medicare BlueFlex (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 BlueFlex (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 BlueFlex (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 BlueFlex (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $22.00. 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 $275.00 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:
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Drug Coverage
The Medicare BlueFlex (PPO) plan has a $275 deductible for prescription drugs. After meeting your deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $12 copay at preferred pharmacies. 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 covered drugs.
Additional Benefits
The Medicare BlueFlex (PPO) plan offers a variety of benefits, including inpatient and outpatient hospital services with copays ranging from $300-$375. You'll find coverage for emergency services, primary care, preventive services, home health, hearing, vision, and dental services, each with their own specific copays or coinsurance amounts. The plan also covers partial hospitalization, ambulance services, dialysis, medical equipment, and diagnostic services, with various cost-sharing structures. This plan includes additional benefits such as skilled nursing facility stays, with no copay for the first 20 days, and dental services with a $35 copay. It also provides limited coverage for acupuncture, vision, and hearing services. However, some services are not covered, such as certain cardiac rehabilitation services, and additional hours of home health care.
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 $375 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $315 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay 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, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services, Observation Services, and Ambulatory Surgical Center Services each have a $300 copay, and Outpatient Substance Abuse Services have a 20% coinsurance for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Medicare BlueFlex (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 BlueFlex (PPO) plan. Ground and Air Ambulance Services have a $305 copay, with no coinsurance, 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 under the Medicare BlueFlex (PPO) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $305 copay. There is no coinsurance for any of these services.
Primary Care See details
The Medicare BlueFlex (PPO) plan covers primary care physician services, chiropractic services with a $5 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, and physical therapy and speech-language pathology services with a $35 copay. Mental health specialty services and psychiatric services are covered with 20% coinsurance, and other healthcare professional services have a 50% coinsurance with a $35 copay. Additional telehealth benefits are covered with 20% coinsurance and a copay between $0 and $35, and opioid treatment program services have a 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Medicare BlueFlex (PPO) plan covers preventive services, including annual physical exams, health education, fitness benefits, enhanced disease management, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. However, the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss, 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, additional sessions of smoking cessation counseling, telemonitoring services, home and bathroom safety devices, or counseling services.
Hearing Services See details
Hearing Services with the Medicare BlueFlex (PPO) plan include routine hearing exams with a $35 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $499 and $799, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eyewear, including contact lenses, has a $35 copay, while routine eye exams are covered once per year.
Dental Services See details
The Medicare BlueFlex (PPO) plan covers dental services, including oral exams, dental x-rays, and prophylaxis (cleaning), with a $35 copay, but does not cover fluoride treatment. Orthodontic services are covered up to a maximum of $1000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Medicare BlueFlex (PPO) plan. 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 BlueFlex (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the Medicare BlueFlex (PPO) plan, including durable medical equipment (DME) with 20% coinsurance and prosthetics/medical supplies with 20% coinsurance. Diabetic equipment is covered, with coinsurance for Medicare-covered diabetic supplies and a $5 copay for diabetic supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Medicare BlueFlex (PPO) plan. Diagnostic procedures and tests, and lab services are not covered. Diagnostic Radiological Services have a copay of $300 and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $60 copay.
Home Health Services See details
Home Health Services are covered by the Medicare BlueFlex (PPO) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Medicare BlueFlex (PPO) plan. 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 BlueFlex (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. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Medicare BlueFlex (PPO) plan covers acupuncture with a 50% coinsurance, up to 10 treatments per year. However, over-the-counter items, meal benefits, and other listed services are not covered.
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