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Medicare Blue Choice Optimum (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare Blue Choice Optimum (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medicare Blue Choice Optimum (HMO-POS) in 2025, please refer to our full plan details page.
Medicare Blue Choice Optimum (HMO-POS) is a HMO-POS 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 Optimum (HMO-POS) 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 Optimum (HMO-POS).
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 Optimum (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $200.70. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6700.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Optimum (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for generic drugs, and coinsurance for brand name and non-preferred drugs. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you will pay nothing for Part D covered drugs.
Additional Benefits
The Medicare Blue Choice Optimum (HMO-POS) plan offers a variety of benefits, including inpatient hospital stays with a $285 copay for the first five days, and no copay for days 6-90. Outpatient services have varying copays, such as $250 for outpatient hospital services, and $110 for emergency services. The plan also covers primary care, preventive services, hearing, vision, and dental services, each with specific copays or coinsurance amounts. Additional benefits include ambulance services, home health with no copay, and skilled nursing facility services. The plan covers home infusion and dialysis services with copays and coinsurance, while medical equipment and diagnostic services are covered with various copays and coinsurance.
Inpatient Hospital See details
The Inpatient Hospital benefit includes coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $285 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. Inpatient Hospital Psychiatric services also have a $285 copay for days 1-5, and no copay for days 6-90. 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 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 $250 copay, while outpatient substance abuse services have a 20% coinsurance for both individual and group sessions.
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
Ambulance and Transportation Services are covered, with a $150 copay for both ground and air ambulance services. Transportation services to any health-related location are covered for up to 12 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $150 copay.
Primary Care See details
Under the Medicare Blue Choice Optimum (HMO-POS) plan, primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, psychiatric services, physical therapy and speech-language pathology services, opioid treatment program services, and additional telehealth benefits are covered. Chiropractic services have a $15 copay, physician specialist services and physical therapy/speech-language pathology services have a $30 copay, and occupational therapy has a $30 copay, while mental health and psychiatric services, other health care professional services, and opioid treatment program services have a 20% coinsurance.
Preventive Services See details
The Medicare Blue Choice Optimum (HMO-POS) plan covers preventive services including Medicare-covered zero-dollar preventive services, annual physical exams, health education, fitness benefits, enhanced disease management, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. 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, 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 exams are covered with a $30 copay, and routine hearing exams are limited to 1 visit every year. Fitting/Evaluation for Hearing Aids are also covered. Prescription hearing aids are covered, with a copay between $499 and $799 for all types, with a limit of 2 visits every year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $40 copay, and eyewear with a $30 copay for contact lenses. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for oral exams with a $30 copay, 2 visits per year, and Dental X-Rays with a $30 copay, 2 visits per year, as well as prophylaxis (cleaning) with a $30 copay, 2 visits per year; however, fluoride treatment is not covered. Orthodontic services are covered up to a maximum of $1000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. Insulin has a $35 copay for Medicare Part B drugs, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Medicare Blue Choice Optimum (HMO-POS) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. DME has a 20% coinsurance and requires prior authorization, while durable medical equipment for use outside the home is not covered. Prosthetic devices, medical supplies, and diabetic therapeutic shoes/inserts also have a 20% coinsurance, while diabetic supplies have a $5 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Medicare Blue Choice Optimum (HMO-POS) plan. Diagnostic procedures/tests and lab services are not covered, while Diagnostic Radiological Services have a copay of at most $150, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered under the Medicare Blue Choice Optimum (HMO-POS) plan with no copay or coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Medicare Blue Choice Optimum (HMO-POS) plan. Although the plan covers Cardiac Rehabilitation Services, the specific services of Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, Additional Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Under Other Services, acupuncture is covered with a 50% coinsurance, up to 10 treatments per year. Over-the-counter items are covered, with a maximum benefit of $50 every three months, and include nicotine replacement therapy. Meal benefits are also covered for chronic illness. Other services such as Early and Periodic Screening, Diagnostic, and Treatment Services, and case management are not covered.
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