A non-government entity
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 2026, 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 Greater Rochester Area. This plan received an overall rating of 4 out of 5 stars in 2026.
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 $224.80. 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 $100.00 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 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:
Sign up for Medicare Blue Choice Optimum (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Medicare Blue Choice Optimum (HMO-POS) plan features an annual drug deductible of $100. For Tier 1 preferred generic drugs, members pay no copay when using preferred pharmacies or preferred mail-order services. Tier 2 generic medications cost a $5 copay for a one-month supply at preferred locations, while standard pharmacies charge a $10 copay. Tier 3 preferred brand drugs require a 20% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs carry a 37% coinsurance at preferred locations and a 50% coinsurance at standard locations. Tier 5 specialty medications have a 31% coinsurance regardless of which pharmacy network you choose.
Additional Benefits
The Medicare Blue Choice Optimum (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits and preventive services. If you require specialist visits, you will pay a $30 copay, while outpatient hospital services carry a $250 copay. For inpatient hospital stays, there is no coinsurance and a $285 daily copay for the first five days, followed by no copay for days six through ninety. This plan also includes essential dental, vision, and hearing benefits with no deductibles. Covered preventive and comprehensive dental services require no copay or coinsurance, while routine hearing exams cost $30 and routine vision exams require a $40 copay. Additionally, home health services are available with no copay or coinsurance, and emergency room visits are covered with a $115 copay that is waived upon hospital admission.
Inpatient Hospital See details
Medicare Blue Choice Optimum (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $285 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Medicare Blue Choice Optimum (HMO-POS) covers outpatient hospital, observation, and ambulatory surgical center services with a $250 copay and no coinsurance. Outpatient substance abuse services require no copay but have a 20% coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered under the Medicare Blue Choice Optimum (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Medicare Blue Choice Optimum (HMO-POS) covers ground and air ambulance services with a $150 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, offering up to 12 one-way trips per year to any health-related location with no copay or coinsurance, though transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Medicare Blue Choice Optimum (HMO-POS) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 23 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $40 to $150.
Primary Care See details
Medicare Blue Choice Optimum (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits and physical, occupational, and speech therapies require a $30 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services feature no copay and a 20% coinsurance, though podiatry is not covered and chiropractic care is only partially covered with a $15 copay and no coinsurance.
Preventive Services See details
Medicare Blue Choice Optimum (HMO-POS) provides partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and diabetes self-management training. Excluded sub-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 for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Medicare Blue Choice Optimum (HMO-POS) covers routine hearing exams with a $30 copay and no coinsurance, and there is no deductible. Prescription hearing aids are partially covered with a copay ranging from $499.00 to $799.00 and no coinsurance for up to two devices per year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Medicare Blue Choice Optimum (HMO-POS) with no deductibles, featuring one routine eye exam per year for a $40 copay and no coinsurance, while other eye exams are not covered. Eyewear is partially covered with a $30 copay, no coinsurance, and a $200 annual maximum for contact lenses and eyeglasses, though individual eyeglass lenses, frames, and upgrades are excluded.
Dental Services See details
Dental services are partially covered by Medicare Blue Choice Optimum (HMO-POS), offering Medicare-covered dental services for a $30 copay and no coinsurance, and other covered preventive and comprehensive dental services with no copay and no coinsurance. Sub-services that are not covered under this plan include other diagnostic dental, fluoride treatment, other preventive dental, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Medicare Blue Choice Optimum (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while Medicare Part B chemotherapy and other Part B drugs require 0% to 20% coinsurance.
Dialysis Services See details
Medicare Blue Choice Optimum (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare Blue Choice Optimum (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes or inserts are also covered with a $5 copay or 20% coinsurance, and prior authorization is required for most equipment.
Diagnostic and Radiological Services See details
Medicare Blue Choice Optimum (HMO-POS) covers diagnostic and radiological services with prior authorization, though some diagnostic services are covered while diagnostic procedures, tests, and lab services are not. Covered diagnostic services require no copay or coinsurance, whereas radiological services require a $150 minimum copay for diagnostic radiology, a 20% minimum coinsurance for therapeutic radiology, and a $40 copay for outpatient X-rays.
Home Health Services See details
Home health services are covered by Medicare Blue Choice Optimum (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Medicare Blue Choice Optimum (HMO-POS) with no coinsurance and a $15 copay for covered services. However, standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered in practice under this plan.
Skilled Nursing Facility (SNF) See details
Medicare Blue Choice Optimum (HMO-POS) 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, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Medicare Blue Choice Optimum (HMO-POS) partially covers other services, offering up to 10 acupuncture treatments per year with no copay and a 50% coinsurance, as well as chronic illness meal benefits with no copay or coinsurance. Over-the-counter (OTC) items are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved