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Univera SeniorChoice Extra (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Univera SeniorChoice Extra (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Univera SeniorChoice Extra (HMO) in 2026, please refer to our full plan details page.
Univera SeniorChoice Extra (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 Extra (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 Extra (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 Extra (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. Additionally, this plan comes with a Part B Premium reduction of $44.10. You must continue to pay paying your reduced 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 Extra (HMO) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay a low copay of $6 for a one-month supply at preferred pharmacies and mail-order services, or $11 at standard pharmacies. Tier 2 generic drugs are also highly affordable, with a one-month copay starting at $15 at preferred pharmacies and rising to $20 at standard locations. Higher-tier medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance at preferred pharmacies and 25% at standard pharmacies, while Tier 4 non-preferred drugs range from 30% to 40% coinsurance depending on your pharmacy choice. Specialty medications in Tier 5 carry a flat 25% coinsurance regardless of whether you use a preferred or standard pharmacy or mail-order service.
Additional Benefits
The Univera SeniorChoice Extra (HMO) offers comprehensive medical coverage with predictable cost-sharing, featuring a $5 copay for primary care visits, a $45 copay for specialists, and no coinsurance for either. For hospital stays, members pay a daily copay of $400 for days 1 through 5 of acute inpatient care and a $400 copay for outpatient hospital services, both with no coinsurance. Emergency room visits require a $115 copay, which is waived if admitted, while urgent care visits carry a $40 copay. This plan also includes valuable supplemental benefits, such as routine eye exams and preventive dental services with no copay or coinsurance. Routine hearing exams are available for a $45 copay, and prescription hearing aids are covered with copays ranging from $499 to $799. Additionally, members benefit from a quarterly $30 over-the-counter item allowance and skilled nursing facility care with no copay for the first 20 days.
Inpatient Hospital See details
Univera SeniorChoice Extra (HMO) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $400 for days 1 through 5 of an acute stay and $374 for days 1 through 5 of a psychiatric stay, followed by no copay for subsequent days. Prior authorization is required, and specific sub-services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Univera SeniorChoice Extra (HMO) covers outpatient hospital, observation, and ambulatory surgical center services with a $400 copay and no coinsurance. Outpatient substance abuse services are covered with no copay and a 20% coinsurance, while outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Univera SeniorChoice Extra (HMO) with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Univera SeniorChoice Extra (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance, requiring prior authorization. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Univera SeniorChoice Extra (HMO) covers emergency services with a $115 copay—waived if admitted to the hospital within 23 hours—and urgent care with a $40 copay, with no coinsurance required for either service. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance, requiring copays of $115, $40, and $300 respectively.
Primary Care See details
Univera SeniorChoice Extra (HMO) covers primary care visits for a $5 copay and specialist visits for a $45 copay, both with no coinsurance. Physical and occupational therapy require a $35 copay with no coinsurance, while mental health and psychiatric services feature no copay and a 20% coinsurance. Podiatry and chiropractic services are not covered under this plan.
Preventive Services See details
Univera SeniorChoice Extra (HMO) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, and memory fitness. However, many additional services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and counseling.
Hearing Services See details
Hearing services are partially covered by Univera SeniorChoice Extra (HMO), which offers one routine hearing exam annually for a $45 copay and no coinsurance, and up to two prescription hearing aids per year with copays ranging from $499 to $799 and no coinsurance. Fitting and evaluation services are covered with no coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Univera SeniorChoice Extra (HMO) provides partially covered vision services, including one annual routine eye exam with no deductible, no copay, and no coinsurance. Eyewear is also partially covered with a $45 copay for contact lenses, no coinsurance, and a $150 annual limit, but other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Univera SeniorChoice Extra (HMO) offers partially covered dental services with a $45 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for covered preventive and comprehensive services. Specific sub-services that are not covered include other diagnostic dental services, fluoride treatment, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Univera SeniorChoice Extra (HMO) with no copay, though prior authorization is required and step therapy may apply. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Univera SeniorChoice Extra (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Univera SeniorChoice Extra (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies require a $5 copay with no coinsurance, while diabetic therapeutic shoes and inserts are covered with no copay and a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Univera SeniorChoice Extra (HMO), with diagnostic tests and lab services requiring a $15 copay and no coinsurance. Diagnostic radiological services carry a minimum $325 copay, outpatient X-rays require a $60 copay, and therapeutic radiological services have a 20% coinsurance, with prior authorization required for these services.
Home Health Services See details
Home Health Services are covered by Univera SeniorChoice Extra (HMO) 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 Extra (HMO) with no coinsurance and applicable copayments. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Univera SeniorChoice Extra (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day 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 Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Univera SeniorChoice Extra (HMO), which offers acupuncture with no copay and 50% coinsurance for up to 10 treatments per year, and over-the-counter items with no copay and no coinsurance up to $30 every three months, while meal benefits are not covered.
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