A non-government entity
CDPHP Choice Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CDPHP Choice Rx (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CDPHP Choice Rx (HMO) in 2026, please refer to our full plan details page.
CDPHP Choice Rx (HMO) is a HMO plan offered by Lifetime Healthcare, Inc. available for enrollment in 2025 to people living in Greater Capital Region of New York State. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that CDPHP Choice Rx (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 CDPHP Choice Rx (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 CDPHP Choice Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $135.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6000.00 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:
Sign up for CDPHP Choice Rx (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The CDPHP Choice Rx (HMO) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail-order service, copays for these lower-tier drugs range from $3 to $16 for a one-month supply. Tier 3 preferred brand-name drugs require a copay starting at $40 at preferred locations and $45 at standard locations for a one-month supply. Higher-tier prescriptions carry coinsurance rather than set copays, with Tier 4 non-preferred drugs requiring a 40% coinsurance and Tier 5 specialty drugs requiring a 33% coinsurance for a one-month supply.
Additional Benefits
The CDPHP Choice Rx (HMO) plan offers comprehensive coverage with predictable costs, featuring no copays for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a daily copay of $260 for the first six days and no copay for subsequent days, while emergency room visits carry a $100 copay. Outpatient services and ambulatory surgical center visits are also covered with no coinsurance, requiring copays ranging from $200 to $260. Specialty services under this plan are highly affordable, including dental care with no copay for preventive services up to a $1,650 annual limit and routine eye exams with no copay. Prescription hearing aids are available with copays between $199 and $499, while medical equipment and dialysis services generally require a 20% coinsurance with no copay. Additionally, members benefit from unlimited transportation to plan-approved locations and a $50 quarterly over-the-counter allowance with no copay or coinsurance.
Inpatient Hospital See details
CDPHP Choice Rx (HMO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $260 daily copay for days 1 through 6 and no copay for days 7 and beyond. Prior authorization and referrals are required, and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
CDPHP Choice Rx (HMO) covers outpatient services with no coinsurance, featuring a $250 copay for outpatient hospital services, a $260 daily copay for observation services, and a $200 copay for ambulatory surgical center services. Outpatient substance abuse services require a $25 copay per individual or group session with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
CDPHP Choice Rx (HMO) covers partial hospitalization services with a $100 copay and no coinsurance, although a referral may be required.
Ambulance and Transportation Services See details
CDPHP Choice Rx (HMO) covers ground and air ambulance services with a $185 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, offering unlimited round trips to plan-approved locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
CDPHP Choice Rx (HMO) covers emergency services with a $100 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $50 to $185.
Primary Care See details
CDPHP Choice Rx (HMO) covers primary care physician visits and opioid treatment with no copay and no coinsurance, while specialist visits, mental health, and therapy services have copays ranging from $0 to $25 and no coinsurance. Chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by CDPHP Choice Rx (HMO) with no copay and no coinsurance for covered services such as annual physical exams, kidney disease education, and weight management. Sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, alternative therapies, therapeutic massage, adult day health, home-based palliative care, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services covered under CDPHP Choice Rx (HMO) include exams and fitting evaluations for a copay of up to $25 and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a $199 to $499 copay, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are partially covered under CDPHP Choice Rx (HMO) with no deductibles, offering one annual routine eye exam with no copay or coinsurance, while other eye exams and upgrades are not covered. Covered eyewear, including eyeglasses and contact lenses, has no copay and a 20% coinsurance up to a $300 annual combined maximum.
Dental Services See details
CDPHP Choice Rx (HMO) covers Medicare-covered dental services with a $25 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance. These additional dental services are subject to a maximum plan benefit coverage of $1,650 every year.
Home Infusion bundled Services See details
CDPHP Choice Rx (HMO) covers home infusion bundled services with prior authorization, offering Medicare Part B insulin drugs for a $35 copay and no coinsurance. Other covered Part B drugs require a $35 copay and 0% to 20% coinsurance, while chemotherapy and radiation drugs require a copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the CDPHP Choice Rx (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
CDPHP Choice Rx (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic services, with prior authorization required. For DME, prosthetics, and diabetic therapeutic shoes, you will pay no copay and a 20% coinsurance (up to $250 maximum per item), while diabetic supplies require a $5 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by CDPHP Choice Rx (HMO), requiring referrals and prior authorization for all services. Members pay no copay or coinsurance for lab services, a $0 to $25 copay with no coinsurance for diagnostic tests, a $5 copay for X-rays, a minimum $100 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered under the CDPHP Choice Rx (HMO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by CDPHP Choice Rx (HMO), and while some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by CDPHP Choice Rx (HMO) with no coinsurance, though prior authorization and referrals are required. There is no copay for days 1 through 20 and a $120 daily copay for days 21 through 100, with no prior three-day hospital stay required and no coverage for days beyond the Medicare-covered limit.
Other Services See details
CDPHP Choice Rx (HMO) partially covers other services, including acupuncture with no copay and 50% coinsurance for up to 10 yearly treatments, as well as meal benefits and up to $50 in quarterly over-the-counter reimbursements with no copay and no coinsurance. Additional miscellaneous services (Other 1, Other 2, and Other 3) are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved