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Medicare Blue Choice Advanced (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare Blue Choice Advanced (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 Advanced (HMO-POS) in 2025, please refer to our full plan details page.
Medicare Blue Choice Advanced (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 Advanced (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 Advanced (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 Advanced (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $37.30. 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 a $300.00 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 $8000.00 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 Advanced (HMO-POS) plan has a $300 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay a $15 copay for preferred generic drugs at a preferred pharmacy. You will pay 50% coinsurance for preferred brand drugs, regardless of the pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Medicare Blue Choice Advanced (HMO-POS) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services, including substance abuse, have copays or coinsurance. Emergency and primary care services have copays, and preventive services are covered. This plan also covers hearing, vision, and dental services with copays and limitations. Home health, skilled nursing, and dialysis services are covered, along with medical equipment and diagnostic services with varying cost-sharing. Additional benefits include ambulance services, and some outpatient services.
Inpatient Hospital See details
Inpatient Hospital services include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you will pay a $400 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $375 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered; Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for all 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 $350.00. Outpatient substance abuse services have a 20% coinsurance for both individual and group sessions.
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 under the Medicare Blue Choice Advanced (HMO-POS) plan. Both ground and air ambulance services have a $275 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered under the Medicare Blue Choice Advanced (HMO-POS) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $275 copay; all services have no coinsurance.
Primary Care See details
The Medicare Blue Choice Advanced (HMO-POS) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, and occupational therapy services with a $35 copay. The plan also covers physician specialist services with a $40 copay, mental health specialty services, psychiatric services, physical therapy, and speech-language pathology services with a $35 copay, and opioid treatment program services with 20% coinsurance. Additionally, Additional Telehealth Benefits are covered with 20% coinsurance and a copay between $0 and $40.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services, annual physical exams, health education, fitness benefits, enhanced disease management, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. 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. Remote access technologies are covered.
Hearing Services See details
Hearing Services include hearing exams with a $40 copay, and Routine Hearing Exams with 1 visit allowed every year, and Fitting/Evaluation for Hearing Aid with unlimited visits. 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, nor are OTC Hearing Aids.
Vision Services See details
Vision Services includes coverage for eye exams, with no copay, and eyewear. Eyewear has a $40 copay for contact lenses, and a maximum plan benefit of $150 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for oral exams, dental x-rays, and prophylaxis (cleaning) with a $40 copay for Medicare Dental Services. Other dental services include coverage for restorative services, adjunctive general services, endodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, with a maximum annual benefit of $1,000 for orthodontic services. Fluoride treatment, 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. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Medicare Blue Choice Advanced (HMO-POS) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, with a $5 copay for Diabetic Supplies, and 20% coinsurance for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Medicare Blue Choice Advanced (HMO-POS) plan. Diagnostic Procedures/Tests and Lab Services have a $10 copay, while Diagnostic Radiological Services have a $250 copay, and Outpatient X-Ray Services have a $50 copay. Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Medicare Blue Choice Advanced (HMO-POS) plan with no copay or coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. 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 under the Medicare Blue Choice Advanced (HMO-POS) plan. You will have no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The "Other Services" benefit with the Medicare Blue Choice Advanced (HMO-POS) plan covers acupuncture with a 50% coinsurance, and over-the-counter (OTC) items, with a maximum benefit of $30 every three months. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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