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Univera SeniorChoice Value Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Univera SeniorChoice Value Plus (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Univera SeniorChoice Value Plus (HMO-POS) in 2025, please refer to our full plan details page.
Univera SeniorChoice Value Plus (HMO-POS) is a HMO-POS 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 Value Plus (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 Univera SeniorChoice Value Plus (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 Univera SeniorChoice Value Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $57.30. 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 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 Univera SeniorChoice Value Plus (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance based on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $10 copay at a preferred pharmacy. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, also known as LIS or "Extra Help".
Additional Benefits
The Univera SeniorChoice Value Plus (HMO-POS) plan provides a variety of benefits with varying cost-sharing. Hospital stays have a copay, with lower costs after the fifth day. Outpatient services and emergency care have copays, while services like mental health and dialysis have coinsurance. This plan offers coverage for primary care, hearing, vision, and dental services, each with its own cost structure. Additionally, the plan covers home health services with no copay and provides benefits for medical equipment and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization. For Inpatient Hospital-Acute, you will pay a $310 copay for days 1-5, and no copay for days 6-90, while Inpatient Hospital Psychiatric services have the same cost-sharing structure.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services, observation services, and ambulatory surgical center services have a $260 copay, while outpatient substance abuse services have a 20% coinsurance for individual and group sessions.
Partial Hospitalization See details
Univera SeniorChoice Value Plus (HMO-POS) covers partial hospitalization with a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Univera SeniorChoice Value Plus (HMO-POS) plan. Both Medicare-covered Ground and Air Ambulance Services have a $200 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 by the Univera SeniorChoice Value Plus (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $50 copay, and Worldwide Emergency Transportation has a $200 copay; all have no coinsurance.
Primary Care See details
The Univera SeniorChoice Value Plus (HMO-POS) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, mental health specialty services with 20% coinsurance, other health care professional services with a $35 copay and 50% coinsurance, psychiatric services with 20% coinsurance, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with 20% coinsurance and a copay from $0-$35, and opioid treatment program services with 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Univera SeniorChoice Value Plus (HMO-POS) plan covers preventive services, including annual physical exams, health education, and fitness benefits, but does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, 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, and telemonitoring services, home and bathroom safety devices, and counseling services. Other covered services include kidney disease education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit.
Hearing Services See details
Hearing Services include routine hearing exams with a $35 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a copay between $499 and $799 for all types, 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
The Univera SeniorChoice Value Plus (HMO-POS) plan covers vision services, including routine eye exams once per year with no copay. Eyewear has a $35 copay for contact lenses, with a combined maximum plan benefit of $200 every year, and eyeglasses (lenses and frames) are also covered. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $35 copay. Oral exams, dental x-rays, and prophylaxis (cleaning) are covered, but fluoride treatment is not covered. Orthodontic services are covered up to a maximum of $1,000 per year, and restorative services, adjunctive general services, endodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are also covered. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Univera SeniorChoice Value Plus (HMO-POS) plan, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Univera SeniorChoice Value Plus (HMO-POS) plan. You will pay 20% coinsurance 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 authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay. Diabetic Supplies have a $5 copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic procedures and lab services are not covered. For Diagnostic Radiological Services, there is a copay of at most $175.00. Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a copay of $50.00.
Home Health Services See details
Home Health Services are covered by the Univera SeniorChoice Value Plus (HMO-POS) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Univera SeniorChoice Value Plus (HMO-POS) plan. However, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, Additional Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, and Pulmonary Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Univera SeniorChoice Value Plus (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Univera SeniorChoice Value Plus (HMO-POS) covers acupuncture with a 50% coinsurance, but is limited to 10 treatments every year. Over-the-counter (OTC) items are covered, including nicotine replacement therapy, up to $50 every three months. Other services such as meal benefits, and additional services are not covered.
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