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Univera SeniorChoice Core (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Univera SeniorChoice Core (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Univera SeniorChoice Core (PPO) in 2026, please refer to our full plan details page.
Univera SeniorChoice Core (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 3.5 out of 5 stars in 2026.
It's important to know that Univera SeniorChoice Core (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 Core (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 Core (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $232.20. 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 $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 $5750.00 (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 $5750.00 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 Univera SeniorChoice Core (PPO) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics, you will pay a low copay starting at $3 for a one-month supply at preferred pharmacies and preferred mail-order services, or $8 at standard pharmacies. Tier 2 generic drugs are also affordable, costing a $15 copay for a one-month supply at preferred locations and a $20 copay at standard locations. For brand-name and non-preferred drugs, your costs transition to coinsurance, with Tier 3 preferred brands requiring 22% coinsurance at preferred pharmacies and 25% at standard pharmacies. Tier 4 non-preferred drugs carry a 25% coinsurance at preferred pharmacies and up to 50% at standard pharmacies, while Tier 5 specialty drugs require a flat 25% coinsurance across all pharmacy options. Utilizing preferred pharmacies and mail-order services can help you maximize your savings on most prescription tiers.
Additional Benefits
The Univera SeniorChoice Core (PPO) plan offers affordable coverage for core medical needs, featuring no copay for primary care visits, home health care, and annual routine eye exams. For specialist visits, physical therapy, and mental health services, members pay a low $15 copay with no coinsurance. Inpatient hospital stays require a $100 daily copay for the first five days, while emergency room visits carry a $115 copay that is waived upon hospital admission. Other services under this plan require cost-sharing, such as a 20% coinsurance for durable medical equipment, dialysis, and therapeutic radiology. Routine hearing exams and Medicare-covered dental services both carry a $15 copay, though routine dental cleanings, eyeglasses, and over-the-counter items are not covered by the plan. Additionally, covered prescription hearing aids require copays ranging from $499 to $799.
Inpatient Hospital See details
Univera SeniorChoice Core (PPO) covers inpatient hospital services with no coinsurance, requiring a $100 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Univera SeniorChoice Core (PPO) outpatient services are covered with no coinsurance, featuring a $75 copay for outpatient hospital, observation, and ambulatory surgical center services. Outpatient substance abuse services require a $15 copay per individual or group session with no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under Univera SeniorChoice Core (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Univera SeniorChoice Core (PPO), featuring a $100 copay and no coinsurance for both ground and air ambulance services, which require prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Univera SeniorChoice Core (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 23 hours, and urgently needed services with a $30 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $115, $30, and $100 respectively.
Primary Care See details
Univera SeniorChoice Core (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $15 copay and no coinsurance. Podiatry services are not covered, and chiropractic benefits are only partially covered, as routine and other chiropractic services are excluded.
Preventive Services See details
Preventive Services are partially covered by Univera SeniorChoice Core (PPO) with no copay and no coinsurance for covered options such as annual physical exams, kidney disease education, memory fitness, and remote access technologies. Excluded services that are not covered include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Univera SeniorChoice Core (PPO) partially covers hearing services, offering routine annual exams with a $15 copay, no coinsurance, and no deductible, but excluding OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids. Covered prescription hearing aids are limited to two per year with no coinsurance and copays ranging from $499 to $799.
Vision Services See details
Vision services are covered by Univera SeniorChoice Core (PPO), featuring partially covered eye exams with no deductible, no copay, and no coinsurance for one routine exam per year, while other eye exam services are not covered. Although some eyewear services are covered with no deductible, a $15 copay, and no coinsurance, contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Univera SeniorChoice Core (PPO) provides partial coverage for Dental Services, covering only Medicare-covered dental services with a $15.00 copay and no coinsurance. Other dental services, including oral exams, cleanings, x-rays, fluoride, restorative services, and orthodontics, are not covered.
Home Infusion bundled Services See details
Univera SeniorChoice Core (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 require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Univera SeniorChoice Core (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Univera SeniorChoice Core (PPO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies require a $5 copay, while diabetic therapeutic shoes and inserts carry a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Univera SeniorChoice Core (PPO), though diagnostic procedures, lab services, and outpatient X-ray services are not covered. Covered diagnostic services require no copay or coinsurance, while diagnostic radiological services require a $50 copay and therapeutic radiological services require a 20% coinsurance, with prior authorization required for both.
Home Health Services See details
Home Health Services are covered under the Univera SeniorChoice Core (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Univera SeniorChoice Core (PPO) with no coinsurance and a $15 copay for covered services. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Univera SeniorChoice Core (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Univera SeniorChoice Core (PPO) partially covers other services, offering coverage for 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.
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