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Medicare Blue Choice Select (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare Blue Choice Select (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medicare Blue Choice Select (HMO) in 2025, please refer to our full plan details page.
Medicare Blue Choice Select (HMO) is a HMO 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 Select (HMO) 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 Select (HMO).
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 Select (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $380.00 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 $8900.00 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 Select (HMO) plan has a $380 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, for preferred generic drugs, you will pay a $15 copay at a preferred pharmacy. For preferred brand drugs, you will pay 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Medicare Blue Choice Select (HMO) plan offers a range of benefits with varying costs. This plan covers inpatient hospital stays with copays, and outpatient services like hospital visits and substance abuse treatment. Emergency services have copays, and primary care visits start with a $5 copay. This plan includes coverage for preventive, hearing, vision, and dental services, each with its own set of copays or coinsurance. Other benefits include home health services with no copay, medical equipment with coinsurance, and home infusion services with copays or coinsurance. There is also coverage for skilled nursing facilities with a copay after the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $425 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you pay a $350 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while 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 includes 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 have a copay of $340, while Outpatient Substance Abuse Services have a 20% coinsurance for both individual and group sessions. Outpatient Blood Services have a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medicare Blue Choice Select (HMO) plan, but requires prior authorization. You will pay a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Medicare Blue Choice Select (HMO). Ground and Air Ambulance Services have a $250 copay, with 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 Medicare Blue Choice Select (HMO) plan. Emergency Services have a $110 copay, and no coinsurance, while Urgently Needed Services have a $45 copay, and no coinsurance. Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
The Medicare Blue Choice Select (HMO) plan covers Primary Care Physician Services with a $5 copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a $45 copay, and Physical Therapy and Speech-Language Pathology Services with a $35 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance for individual and group sessions. Other Health Care Professional services have a 50% coinsurance and a $45 copay, and Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services, including Medicare-covered preventive services, annual physical exams, additional preventive services, kidney disease education services, and other preventive services like glaucoma screening, are covered. Health education, fitness benefits, enhanced disease management, remote access technologies, barium enemas, digital rectal exams, and EKG following welcome visits are also covered. In-home safety assessment, personal emergency response system, 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 benefit, 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 routine hearing exams with a $45 copay, and fitting/evaluation for hearing aids. Prescription Hearing Aids (all types) are covered with a copay between $499 and $799, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $50 copay. Eyewear is covered with a $45 copay for contact lenses, and a combined maximum of $350 per year for all eyewear.
Dental Services See details
Dental services include coverage for Medicare dental services with a $45 copay, as well as oral exams, dental x-rays, and cleaning, each limited to 2 visits per year. Orthodontic services have a maximum benefit of $1000 per year, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, 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 coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Medicare Blue Choice Select (HMO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment and prosthetic devices, is covered by the Medicare Blue Choice Select (HMO) plan. Durable medical equipment has a 20% coinsurance, while prosthetic devices have a 20% coinsurance. 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 by the Medicare Blue Choice Select (HMO) plan. Diagnostic services have no copay, but Diagnostic Procedures/Tests and Lab Services are not covered. Radiological Services have a copay, and Diagnostic Radiological Services have a maximum copay of $250.00, while Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $55.00 copay.
Home Health Services See details
Home Health Services are covered by the Medicare Blue Choice Select (HMO) 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, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. There is a copay for Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medicare Blue Choice Select (HMO) plan, requiring prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered SNF stays and non-Medicare-covered stays are not covered.
Other Services See details
The Medicare Blue Choice Select (HMO) plan covers acupuncture with a 50% coinsurance, but it is limited to 10 treatments per year. Over-the-counter items are covered, with a maximum benefit of $90 every three months, including nicotine replacement therapy. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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