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Medicare Blue Choice Value Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare Blue Choice 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 Medicare Blue Choice Value Plus (HMO-POS) in 2025, please refer to our full plan details page.
Medicare Blue Choice Value Plus (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 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 Medicare Blue Choice 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 Medicare Blue Choice Value Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $72.30. 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 $7200.00 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 Value Plus (HMO-POS) plan has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $15 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The Medicare Blue Choice Value Plus (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with a $300 copay, and ambulance services with a $225 copay. The plan also covers primary care with no copay, vision and hearing services with copays, and dental services with a $30 copay. Additionally, this plan covers a variety of other services, such as home health services with no copay, and diagnostic and radiological services with copays. However, it's important to note that certain services like Cardiac Rehabilitation, and some dental and vision services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization; Inpatient Hospital-Acute has a $350 copay for days 1-5, and no copay for days 6-90, while Inpatient Hospital Psychiatric has a $325 copay for days 1-5 and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for Medicare Blue Choice Value Plus (HMO-POS) covers outpatient hospital services, observation services, and ambulatory surgical center services with a $300 copay. Outpatient Substance Abuse Services are covered with 20% coinsurance, and Outpatient Blood Services are also covered.
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 prior authorization required for all ambulance services. Ground and Air Ambulance Services have a $225 copay, and there is no coinsurance, while 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 Medicare Blue Choice Value Plus (HMO-POS) plan. Emergency Services have a $110 copay with no coinsurance, Urgently Needed Services have a $40 copay with no coinsurance, and Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $225 copay, all with no coinsurance.
Primary Care See details
The Medicare Blue Choice Value Plus (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy with a $30 copay, physician specialist services with a $30 copay, and physical therapy and speech-language pathology services with a $30 copay. Mental health specialty, psychiatric services, and opioid treatment program services are covered with 20% coinsurance. Additional telehealth benefits are covered with 20% coinsurance and a copay between $0 and $30. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Medicare Blue Choice Value Plus (HMO-POS) plan covers preventive services, including Medicare-covered zero-dollar preventive services with prior authorization, annual physical exams, health education, fitness benefits, enhanced disease management, remote access technologies, glaucoma screenings, 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 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 include hearing exams with a $30 copay, and prescription hearing aids with a copay between $499 and $799; routine hearing exams are limited to one per year, and fitting/evaluation for hearing aids is unlimited, while prescription hearing aids are limited to two per year. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams with a $45 copay and eyewear with a $30 copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered. Contact lenses, and eyeglasses (lenses and frames) are covered.
Dental Services See details
Under the Medicare Blue Choice Value Plus (HMO-POS) plan, dental services include a $30 copay for Medicare dental services. Other dental services such as Oral Exams, Dental X-Rays, and Prophylaxis (Cleaning) are covered, but Fluoride Treatment is not. Orthodontic Services are covered up to a $1000 maximum benefit per year, and Restorative Services, Adjunctive General Services, Endodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered. However, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Medicare Blue Choice Value Plus (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and authorization required, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment with varying copays and coinsurance depending on the specific service. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a $4 copay, lab services with a $4 copay, and outpatient X-ray services with a $50 copay. Diagnostic Radiological Services have a copay of at most $175, while Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Medicare Blue Choice Value Plus (HMO-POS) plan with no copay and no 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 Value Plus (HMO-POS) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medicare Blue Choice Value Plus (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, but for days 21-100, there is a $214 copay.
Other Services See details
Other Services includes acupuncture, which has a 50% coinsurance, and over-the-counter items, which are covered up to $50 every three months. Meal benefits, 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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