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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 2025, 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 4 out of 5 stars in 2025.
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 $217.30. 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 $480.00 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) plan has a $480 deductible for prescription drugs. After you meet your deductible, you will pay a copay for your prescriptions depending on the drug tier and the pharmacy you use. For example, you will pay a $5 copay at a preferred pharmacy for preferred generic drugs. For non-preferred drugs, you will pay 27% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Univera SeniorChoice Core (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with a $100 copay for days 1-5 and no copay for days 6-90. Outpatient services, primary care, preventive services, hearing, vision, dental, and home health services are also covered, with varying copays and coinsurance amounts depending on the service. This plan includes coverage for emergency services, ambulance, and home infusion services. There is a $110 copay for emergency services and a $100 copay for ground and air ambulance services. Other benefits include coverage for dialysis services, medical equipment, and diagnostic and radiological services.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a $100 copay for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered, with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, and ambulatory surgical center services with a $75 copay, as well as outpatient substance abuse services with a $15 copay for both individual and group sessions. This plan also covers outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Univera SeniorChoice Core (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 Core (PPO) plan. Ground and Air Ambulance Services have a $100 copay, and there is 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 Univera SeniorChoice Core (PPO) plan. Emergency Services has a $110 copay, and Urgently Needed Services has a $30 copay. Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a $100 copay.
Primary Care See details
The Univera SeniorChoice Core (PPO) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, other health care professionals, psychiatric services, physical therapy and speech-language pathology services, opioid treatment program services, and additional telehealth benefits. Chiropractic, occupational therapy, physician specialist services, physical therapy, and speech-language pathology services have a $15 copay, while other health care professionals have a $15 copay with 50% coinsurance. Additional telehealth benefits have a $0-$15 copay and 20% coinsurance.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, additional preventive services, health education, fitness benefits, enhanced disease management, and remote access technologies are covered. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 are covered, including hearing exams with a $15 copay, and prescription hearing aids with a copay between $499 and $799 per year for all types. Routine hearing exams and fitting/evaluation for hearing aids are also covered, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are also not covered.
Vision Services See details
Vision services include routine eye exams and eyewear benefits. Routine eye exams are covered once per year, and eyewear benefits have a $15 copay for contact lenses; however, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $15 copay for Medicare dental services, but orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 by the Univera SeniorChoice Core (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a $5 copay. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Univera SeniorChoice Core (PPO) plan, but Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of $50, while Therapeutic Radiological Services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the Univera SeniorChoice Core (PPO) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Univera SeniorChoice Core (PPO) plan, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The copay for these services is not specified in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Univera SeniorChoice Core (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture with 50% coinsurance, limited to 10 treatments per year. 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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