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Univera SeniorChoice Basic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Univera SeniorChoice Basic (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Univera SeniorChoice Basic (HMO) in 2025, please refer to our full plan details page.
Univera SeniorChoice Basic (HMO) is a HMO 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 Basic (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 Univera SeniorChoice Basic (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 Univera SeniorChoice Basic (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 $200.00 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 $8500.00 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 Basic (HMO) plan has a $200 deductible for prescription drugs. After meeting the deductible, your cost will vary depending on the drug tier and where you fill your prescription. For preferred and standard generics, you will pay a copay ranging from $14 to $47. For preferred brand drugs, you will pay 50% coinsurance, and for non-preferred drugs, you will pay 30% coinsurance. Once your total yearly out-of-pocket drug costs reach $2000, you will pay nothing for covered Part D drugs.
Additional Benefits
The Univera SeniorChoice Basic (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services and emergency services have copays as well. Primary care visits have a $5 copay, while many other services have either a copay or coinsurance. Preventive services are covered with no copay, and the plan also includes coverage for hearing, vision, and dental services with copays. Additional benefits include ambulance services, home health services, and medical equipment coverage. The plan also has coverage for home infusion services and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $390 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you pay a $315 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, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered by the Univera SeniorChoice Basic (HMO) plan. Outpatient hospital services, observation services, and ambulatory surgical center services have a $285 copay, while outpatient substance abuse services have a 20% coinsurance for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Univera SeniorChoice Basic (HMO) plan. You will pay 20% coinsurance for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $170 copay for both Medicare-covered ground and air ambulance services, and 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 Basic (HMO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $170 copay.
Primary Care See details
The Univera SeniorChoice Basic (HMO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, and occupational therapy services with a $35 copay. Physician Specialist Services have a $35 copay, while mental health specialty services, psychiatric services, and opioid treatment program services have 20% coinsurance. Other Health Care Professional services have a $35 copay and 50% coinsurance, and physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $35. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Univera SeniorChoice Basic (HMO) covers preventive services with no copay, including annual physical exams, health education, fitness benefit and remote access technologies. However, in-home safety assessments, personal emergency response systems, and several other services are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams with a $35 copay. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids are covered with no limit. Prescription hearing aids are covered with a copay between $499 and $799, with a limit of 2 per year, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include coverage for routine eye exams with one visit allowed per year, and eyewear with a $35 copay for contact lenses. Eyeglasses (lenses and frames) are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered. The plan has a combined maximum benefit of $325 per year for eyewear.
Dental Services See details
The Univera SeniorChoice Basic (HMO) plan covers Medicare dental services with a $35 copay, and also covers other dental services including oral exams (2 visits per year), dental x-rays (2 per year), prophylaxis (cleaning) (2 per year), restorative services, adjunctive general services, endodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services have a maximum benefit of $1000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs can range from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Univera SeniorChoice Basic (HMO) plan. There is a 20% coinsurance for this benefit.
Medical Equipment See details
The Univera SeniorChoice Basic (HMO) plan covers Durable Medical Equipment (DME) with 20% coinsurance and no copay, and Prosthetics/Medical Supplies with 20% coinsurance and no copay. Diabetic Supplies have a $5 copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Univera SeniorChoice Basic (HMO) plan. Diagnostic Procedures/Tests and Lab Services are not covered, while Diagnostic Radiological Services have a copay of $200 and Therapeutic Radiological Services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Univera SeniorChoice Basic (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Univera SeniorChoice Basic (HMO) plan, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. There is a copay for certain Cardiac and Pulmonary Rehabilitation Services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Univera SeniorChoice Basic (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Univera SeniorChoice Basic (HMO) plan covers acupuncture with a 50% coinsurance up to 10 treatments per year, and also covers over-the-counter (OTC) items, including nicotine replacement therapy, up to $90 every three months. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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