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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 2025, 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 2025.
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 $47.00. 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 $350.00 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) plan has a $350 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $12 copay at a preferred pharmacy, while preferred brand drugs have a 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, if you qualify for the low-income subsidy, you will pay nothing for your prescriptions.
Additional Benefits
The Univera SeniorChoice Extra (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays and coinsurance. You'll have a $400 copay for acute inpatient hospital stays for the first five days, and $374 for inpatient psychiatric stays, but no copay for subsequent days. The plan also covers primary care visits for a $5 copay, specialist visits for a $45 copay, and offers hearing and vision services with copays. This plan includes additional benefits like ambulance services with a $300 copay, and dental services with a $45 copay for Medicare-covered dental. It also covers home health services with no copay, and skilled nursing facility care with no copay for the first 20 days. However, it's important to note that certain services like cardiac rehabilitation, and some dental and vision services are not covered.
Inpatient Hospital See details
The Univera SeniorChoice Extra (HMO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $400 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, there is a $374 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while 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 not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, and ambulatory surgical center services with a $400 copay, as well as outpatient substance abuse services with 20% coinsurance. Outpatient blood services are also covered, including services not usually covered by Medicare plans, with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Univera SeniorChoice Extra (HMO) plan. This benefit requires prior authorization and has a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a $300 copay, and there is no coinsurance; however, 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 Univera SeniorChoice Extra (HMO). Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $45 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
The Univera SeniorChoice Extra (HMO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, and physician specialist services with a $45 copay. Occupational therapy services have a $35 copay, and physical therapy and speech-language pathology services have a $35 copay. Mental health and psychiatric services, other healthcare professional services, and opioid treatment program services have 20% coinsurance. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45.
Preventive Services See details
The Univera SeniorChoice Extra (HMO) plan covers preventive services including annual physical exams, health education, fitness benefits, enhanced disease management, remote access technologies, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Some services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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.
Hearing Services See details
Hearing Services include routine hearing exams with a $45 copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $499 and $799, but prescription hearing aids for inner ear, outer ear, and over the ear are not covered, and neither are OTC hearing aids.
Vision Services See details
Vision services include coverage for routine eye exams, with one exam covered every year, and eyewear with a $45 copay for contact lenses, but not for eyeglass lenses, eyeglass frames, or upgrades. The plan offers a combined maximum benefit of $350 per year for eyewear.
Dental Services See details
Dental services include coverage for Medicare dental services with a $45 copay. Other dental services include oral exams, dental x-rays, and cleaning with a limit of two visits per year, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services have a maximum benefit of $1000 per year, while restorative services, adjunctive general services, endodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Univera SeniorChoice Extra (HMO) plan, with prior authorization required. 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 under the Univera SeniorChoice Extra (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Univera SeniorChoice Extra (HMO) plan covers medical equipment, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, including Diabetic Supplies with a $5 copay and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Lab Services have a $15 copay, while Diagnostic Radiological Services have a $325 copay and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $60 copay.
Home Health Services See details
Home Health Services are covered by the Univera SeniorChoice Extra (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Univera SeniorChoice Extra (HMO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Univera SeniorChoice Extra (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services include acupuncture with a 50% coinsurance and a limit of 10 treatments per year, and over-the-counter items with a $90 maximum benefit every three months, including nicotine replacement therapy. Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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