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Univera SeniorChoice Advanced (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Univera SeniorChoice Advanced (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Univera SeniorChoice Advanced (HMO-POS) in 2026, please refer to our full plan details page.
Univera SeniorChoice Advanced (HMO-POS) is a HMO-POS 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 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 Univera SeniorChoice 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 Univera SeniorChoice Advanced (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $50.80. 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 $7500.00 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 Advanced (HMO-POS) plan features an annual drug deductible of $300. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies and preferred mail order, or a $5 copay for a one-month supply at standard pharmacies. Tier 2 generic drugs cost a $5 copay for a one-month supply at preferred locations and a $10 copay at standard pharmacies. For brand-name and specialty prescriptions, Tier 3 preferred brand drugs require a 20% coinsurance across all pharmacies. Tier 4 non-preferred drugs carry a 33% coinsurance at preferred pharmacies and a 50% coinsurance at standard pharmacies. Tier 5 specialty drugs require a 29% coinsurance regardless of which pharmacy you choose.
Additional Benefits
The Univera SeniorChoice Advanced (HMO-POS) plan offers comprehensive medical coverage with predictable cost-sharing, including primary care visits for a $5 copay and specialist consultations for a $30 copay. For hospital stays, there is no coinsurance, though inpatient acute stays require a $360 daily copay for the first five days, followed by no copay for days six through ninety. Emergency care is accessible worldwide for a $115 copay, which is waived upon admission, while urgent care visits require a $40 copay. This plan also features valuable supplemental benefits, such as preventive and comprehensive dental care with no copay up to a $1,000 annual limit, and routine eye exams with no copay. Additionally, members can access routine hearing exams for a $30 copay and receive a quarterly over-the-counter allowance of $30 with no copay. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance, ensuring affordable access to essential medical supplies.
Inpatient Hospital See details
Univera SeniorChoice Advanced (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $360 for days 1-5 of acute stays and $315 for days 1-5 of psychiatric stays, with no copay for days 6-90. Unlimited additional acute days are covered at no copay, while additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Univera SeniorChoice Advanced (HMO-POS) covers outpatient hospital and ambulatory surgical center services with a $330 copay and no coinsurance. Outpatient substance abuse services are covered with no copay and a 20% coinsurance, while outpatient blood services feature no copay and no coinsurance.
Partial Hospitalization See details
Univera SeniorChoice Advanced (HMO-POS) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Univera SeniorChoice Advanced (HMO-POS) covers ground and air ambulance services with a $275 copayment and no coinsurance, though prior authorization is required. For transportation benefits, some services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Univera SeniorChoice Advanced (HMO-POS) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 23 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $115, $40, and $275 respectively.
Primary Care See details
Univera SeniorChoice Advanced (HMO-POS) covers primary care physician services for a $5 copay and no coinsurance, and specialist, physical, and occupational therapy for a $30 copay and no coinsurance. Mental health and psychiatric services feature no copay and a 20% coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Univera SeniorChoice Advanced (HMO-POS) with no copay and no coinsurance for covered care such as annual physical exams, kidney disease education, and glaucoma screenings. Sub-services that are not covered under this benefit include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing Services under Univera SeniorChoice Advanced (HMO-POS) are partially covered, featuring a $30 copay and no coinsurance for an annual routine hearing exam with no deductible. Up to two prescription hearing aids are covered each year with a $499 to $799 copay and no coinsurance, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Univera SeniorChoice Advanced (HMO-POS) offers partially covered vision services with no deductibles, featuring one routine eye exam per year with no copay and no coinsurance. Eyewear is covered up to a $150 annual maximum with a $30 copay and no coinsurance for contact lenses and eyeglasses (lenses and frames), though other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are partially covered by Univera SeniorChoice Advanced (HMO-POS), featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and comprehensive services up to a $1,000 yearly maximum. However, fluoride treatments, implants, orthodontics, maxillofacial prosthetics, other diagnostic dental services, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Univera SeniorChoice Advanced (HMO-POS) covers Home Infusion bundled Services with no copay, requiring prior authorization and step therapy. Under this benefit, Medicare Part B chemotherapy and other Part B drugs have no copay and a coinsurance of 0% to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Univera SeniorChoice Advanced (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Univera SeniorChoice Advanced (HMO-POS) covers medical equipment, featuring durable medical equipment and prosthetics with no copay and 20% coinsurance. Diabetic supplies require a $5 copay and no coinsurance, while diabetic therapeutic shoes and inserts are covered with a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Univera SeniorChoice Advanced (HMO-POS) diagnostic services are partially covered with no copay or coinsurance, though lab services and diagnostic procedures or tests are excluded. Radiological services require prior authorization and include outpatient X-rays for a $55.00 copay and coinsurance, diagnostic radiological services for a minimum $225.00 copay with no coinsurance, and therapeutic radiological services with a 20% minimum coinsurance and a copay.
Home Health Services See details
Univera SeniorChoice Advanced (HMO-POS) 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 under Univera SeniorChoice Advanced (HMO-POS) with a $15 copay and no coinsurance for covered services. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Univera SeniorChoice Advanced (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard 100-day limit are not covered.
Other Services See details
Univera SeniorChoice Advanced (HMO-POS) covers acupuncture with no copay and 50% coinsurance for up to 10 treatments per year, as well as over-the-counter (OTC) items with no copay and no coinsurance up to a $30 limit every three months. Meal benefits and other extra services are not covered under this plan.
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