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CDPHP Clear Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CDPHP Clear Rx (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CDPHP Clear Rx (HMO) in 2026, please refer to our full plan details page.
CDPHP Clear Rx (HMO) is a HMO plan offered by Lifetime Healthcare, Inc. available for enrollment in 2026 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 Clear 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 Clear 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 Clear Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $100.00. 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 a $250.00 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 $6400.00 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 CDPHP Clear Rx (HMO) plan features a $250 drug deductible. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service, while standard options charge a copay starting at $5. Tier 2 generic drugs are also highly affordable, with a copay as low as $2 for a one-month supply through preferred pharmacies and preferred mail order. For higher-tier medications, your costs are determined by coinsurance. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 37% coinsurance across all pharmacy and mail order channels. Tier 5 specialty drugs are available for a one-month supply and require a 30% coinsurance at both preferred and standard locations.
Additional Benefits
The CDPHP Clear Rx (HMO) plan offers robust coverage for essential medical services with predictable out-of-pocket costs. You will pay no copay and no coinsurance for primary care visits, home health services, and annual preventive physicals, while specialist visits and diagnostic tests range from no copay to a $30 copay. Inpatient hospital stays require a $375 daily copay for the first six days and no copay thereafter, while outpatient hospital services carry a $350 copay with no coinsurance. For supplemental care, the plan features dental benefits with no copay up to a $900 annual limit, routine vision exams for a $20 copay, and prescription hearing aids with copays ranging from $599 to $899. Emergency care is covered with a $115 copay, and unlimited health-related transportation is provided with no copay and no coinsurance. However, please note that this plan does not cover over-the-counter items, podiatry, or cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient hospital and psychiatric care are covered by CDPHP Clear Rx (HMO) with no coinsurance, featuring a $375 daily copay for days 1 through 6 and no copay for days 7 and beyond. These benefits are partially covered, as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
CDPHP Clear Rx (HMO) covers outpatient services with no coinsurance, featuring a $350 copay for outpatient hospital services, a $375 daily copay for observation services, and a $275 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $30 copay, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the CDPHP Clear Rx (HMO) plan with a $105.00 copay and no coinsurance. Depending on the provider, a referral may be required to access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by CDPHP Clear Rx (HMO) with prior authorization, featuring a $225 copay and no coinsurance for ground and air ambulance services. Unlimited round-trip transportation to plan-approved health-related locations is available with no copay and no coinsurance, though transportation to any other health-related location is not covered.
Emergency Services See details
Emergency services are covered by CDPHP Clear Rx (HMO) with a $115 copay (waived if admitted to the hospital within 24 hours) and no coinsurance, while urgently needed services require a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $115, $50, and $225 respectively.
Primary Care See details
CDPHP Clear Rx (HMO) offers primary care visits and opioid treatment with no copay and no coinsurance, while specialist visits and telehealth services range from no copay to a $30 copay with no coinsurance. Physical, occupational, speech, and mental health therapies require a $30 copay and no coinsurance, though podiatry is not covered, and for chiropractic care, some services are covered but routine and other chiropractic services are not.
Preventive Services See details
CDPHP Clear Rx (HMO) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. These additional preventive services are only partially covered, as options such as in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing services under CDPHP Clear Rx (HMO) are partially covered, featuring hearing exams and fitting evaluations with a copay of $0 to $30 and no coinsurance or deductible. Prescription hearing aids are limited to two per year with a $599 to $899 copay and no coinsurance, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
CDPHP Clear Rx (HMO) partially covers vision services with no deductibles, offering annual routine eye exams for a $20 copay and other eye exams for a $30 copay, both with no coinsurance. Eyewear is covered with no copay and a 20% coinsurance for contact lenses up to a $250 annual limit, though other eye exam services and upgrades are not covered.
Dental Services See details
CDPHP Clear Rx (HMO) offers partially covered dental services, featuring Medicare-covered dental for a $30 copay and no coinsurance, and other dental benefits with no copay and no coinsurance up to a $900 annual maximum. While most diagnostic, preventive, restorative, and orthodontic services are covered, other preventive dental services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by CDPHP Clear Rx (HMO) with prior authorization and step therapy. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, other Part B drugs have a $35 copay and 0% to 20% coinsurance, and chemotherapy drugs carry a 0% to 20% coinsurance and a copayment.
Dialysis Services See details
Dialysis services are covered by CDPHP Clear Rx (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
CDPHP Clear Rx (HMO) covers medical equipment, including durable medical equipment (DME) and prosthetics, with no copay and a 20% coinsurance capped at $250 per item. Covered diabetic supplies require a $5 copay, while therapeutic shoes and inserts have no copay and a 20% coinsurance capped at $250.
Diagnostic and Radiological Services See details
CDPHP Clear Rx (HMO) covers diagnostic and radiological services, featuring no coinsurance for diagnostic tests and lab services, which carry copays ranging from no copay up to $30. Radiological services require a $5 copay for outpatient X-rays, a minimum $130 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology, with prior authorization and referrals required.
Home Health Services See details
Home health services are covered by CDPHP Clear Rx (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the CDPHP Clear Rx (HMO) plan, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
CDPHP Clear Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a referral but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $200 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
CDPHP Clear Rx (HMO) partially covers other services, offering acupuncture with no copay and 50% coinsurance for up to 10 treatments per year, alongside a home meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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