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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 2026, 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 2026.
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 $615.00 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 features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay a low copay starting at $5 for a one-month supply at preferred pharmacies and preferred mail-order services, up to $30 for a three-month supply at standard locations. Tier 2 generic medications are also cost-effective, with copays ranging from $15 for a one-month preferred supply up to $60 for a three-month standard supply. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands require 21% coinsurance at preferred pharmacies and 25% at standard pharmacies, while Tier 4 non-preferred drugs range from 25% to 40% coinsurance depending on your pharmacy choice. Tier 5 specialty drugs incur a flat 25% coinsurance at both preferred and standard pharmacies, making preferred network pharmacies the most economical choice for your prescriptions.
Additional Benefits
The Univera SeniorChoice Basic (HMO) plan offers affordable medical coverage with low copays for everyday healthcare needs, including a $5 copay for primary care visits and a $30 copay for specialists. For inpatient hospital stays, members pay a $390 daily copay for the first five days and no copay for additional days, while emergency room visits carry a $115 copay. Outpatient surgical services require a $375 copay, whereas home health services and routine annual physicals are covered with no copay. This plan also includes dental, vision, and hearing benefits to help manage your out-of-pocket costs. Dental services feature no copay for covered preventive and comprehensive care up to a $1,000 annual limit, while routine eye exams have no copay and eyewear is covered up to $150 yearly. Additionally, members can take advantage of a $30 quarterly allowance for over-the-counter items with no copay, alongside skilled nursing facility care covered with no copay for the first 20 days.
Inpatient Hospital See details
Univera SeniorChoice Basic (HMO) covers inpatient acute hospital stays with no coinsurance and a $390 copay per day for days 1 through 5, with no copay for additional days, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric care is covered with no coinsurance and a $315 copay per day for days 1 through 5, with no copay for days 6 through 90, though additional psychiatric days are not covered and prior authorization is required for both services.
Outpatient Services See details
Univera SeniorChoice Basic (HMO) covers outpatient hospital and ambulatory surgical center services with a $375 copay and no coinsurance. Outpatient substance abuse services have no copay and a 20% coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under Univera SeniorChoice Basic (HMO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Univera SeniorChoice Basic (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance, though prior authorization is required. Some transportation services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Univera SeniorChoice Basic (HMO) covers emergency services 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 covered with no coinsurance and copays of $115, $40, and $250 respectively.
Primary Care See details
Univera SeniorChoice Basic (HMO) covers primary care physician services for a $5 copay and specialist visits for a $30 copay, both with no coinsurance. Mental health and psychiatric services have no copay and 20% coinsurance, physical and occupational therapy require a $35 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Univera SeniorChoice Basic (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. However, additional preventive services are only partially covered, as the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, disease management, telemonitoring, home/bathroom safety devices, and counseling services.
Hearing Services See details
Univera SeniorChoice Basic (HMO) covers routine hearing exams with a $30 copay and no coinsurance, limited to one visit per year. Prescription hearing aids are partially covered with a copay ranging from $499 to $799 and no coinsurance for up to two devices per year, while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Univera SeniorChoice Basic (HMO), which offers one routine eye exam annually with no copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is covered up to a $150 annual maximum with no deductible and no coinsurance, but carries a $30 copay for contact lenses, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Univera SeniorChoice Basic (HMO) dental services are partially covered, featuring Medicare-covered dental at a $30 copay and no coinsurance, alongside other covered preventive and comprehensive dental services with no copay and no coinsurance up to a $1,000 annual maximum. Excluded services that are not covered include other diagnostic dental, fluoride, other preventive services, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
Univera SeniorChoice Basic (HMO) 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 chemotherapy and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Univera SeniorChoice Basic (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Univera SeniorChoice Basic (HMO) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance, subject to prior authorization. Diabetic supplies are covered with a $5 copay, and diabetic therapeutic shoes or inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Univera SeniorChoice Basic (HMO), as diagnostic procedures, tests, and lab services are not covered. Covered diagnostic services require prior authorization with no copay or coinsurance, while radiological services require prior authorization and involve a $55 copay for X-rays, a minimum $200 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Univera SeniorChoice Basic (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Univera SeniorChoice Basic (HMO) with no coinsurance and a $15 copay, though standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Univera SeniorChoice Basic (HMO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare limit are not covered.
Other Services See details
Univera SeniorChoice Basic (HMO) provides partially covered other services, featuring acupuncture with no copay and 50% coinsurance for up to 10 treatments per year, and over-the-counter (OTC) items with no copay and no coinsurance up to a $30 quarterly limit. Meal benefits and other additional services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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