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Medicare Blue Choice Discovery (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare Blue Choice Discovery (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medicare Blue Choice Discovery (PPO) in 2025, please refer to our full plan details page.
Medicare Blue Choice Discovery (PPO) is a PPO plan offered by Lifetime Healthcare, Inc. available for enrollment in 2025 to people living in Metro Rochester Area. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Medicare Blue Choice Discovery (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 Blue Choice Discovery (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 Blue Choice Discovery (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.30. 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 $590.00 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 Blue Choice Discovery (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $15 copay at a preferred pharmacy and a $20 copay at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Medicare Blue Choice Discovery (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services, partial hospitalization, and ambulance services have copays or coinsurance. The plan also covers emergency services, primary care visits, and preventive services with set copays or no copays. This plan provides coverage for hearing, vision, and dental services, each with specific copays for exams and services like hearing aids and eyewear. Additionally, the plan includes coverage for home infusion, dialysis, medical equipment, and diagnostic services with a combination of copays and coinsurance. Home health services are covered with no cost to the user, while skilled nursing facilities have a copay depending on the length of stay.
Inpatient Hospital See details
Inpatient Hospital services, including those not usually covered by Medicare, are covered under the Medicare Blue Choice Discovery (PPO) plan, with a $450 copay for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric services are also covered, with a $400 copay for days 1-5 and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute has no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all 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 have a copay of $375, while outpatient substance abuse services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
The Medicare Blue Choice Discovery (PPO) plan covers ambulance services with a $325 copay for both ground and air ambulance services, and no coinsurance. 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 Blue Choice Discovery (PPO) plan. Emergency Services has a $110 copay with no coinsurance, Urgently Needed Services has a $45 copay with no coinsurance, and Worldwide Emergency Services has varying copays depending on the service: $110 for Worldwide Emergency Coverage, $45 for Worldwide Urgent Coverage, and $325 for Worldwide Emergency Transportation.
Primary Care See details
The Medicare Blue Choice Discovery (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $45 copay, and physical therapy and speech-language pathology services with a $35 copay. Mental health specialty services and psychiatric services have 20% coinsurance for individual and group sessions. Other health care professional services have a $45 copay and 50% coinsurance. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45, and opioid treatment program services have 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, additional preventive services, and kidney disease education services, are covered by the Medicare Blue Choice Discovery (PPO) plan. Health education, fitness benefits, enhanced disease management, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are also covered. In-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), 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, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a copay between $499 and $799. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a $45 copay, and routine eye exams are covered once per year. Eyewear has a $45 copay with a combined maximum of $150 per year for contact lenses, eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for oral exams with a $45 copay, dental x-rays, prophylaxis (cleaning), and restorative services, with no copay or coinsurance. This plan does not cover fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Medicare Blue Choice Discovery (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 Blue Choice Discovery (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), with a 20% coinsurance and Prosthetic Devices and Medical Supplies with a 20% coinsurance. Diabetic Equipment is covered, with a $5 copay for diabetic supplies and a 20% coinsurance for diabetic therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Medicare Blue Choice Discovery (PPO) plan, which includes coverage for all diagnostic services, lab services, and radiological services. Diagnostic Procedures/Tests have a $5 copay, Lab Services have a $5 copay, Diagnostic Radiological Services have a $250 copay, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Medicare Blue Choice Discovery (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 covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Medicare Blue Choice Discovery (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered SNF and non-Medicare-covered stays are not covered.
Other Services See details
The Medicare Blue Choice Discovery (PPO) plan covers acupuncture with a 50% coinsurance, limited to 10 treatments per year. Other services such as over-the-counter items, meal benefits, and many other services are not covered.
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