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PrimeTime Health Plan Basic - MA Only (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PrimeTime Health Plan Basic - MA Only (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PrimeTime Health Plan Basic - MA Only (HMO-POS) in 2025, please refer to our full plan details page.
PrimeTime Health Plan Basic - MA Only (HMO-POS) is a HMO-POS plan offered by Aultman Health Foundation available for enrollment in 2025 to people living in Operating in 11 counties in Northeastern Ohio. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that PrimeTime Health Plan Basic - MA Only (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about PrimeTime Health Plan Basic - MA Only (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 PrimeTime Health Plan Basic - MA Only (HMO-POS), 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 $75.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3900.00 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
Prescription drugs are not covered by PrimeTime Health Plan Basic - MA Only (HMO-POS).
Additional Benefits
The PrimeTime Health Plan Basic - MA Only (HMO-POS) plan provides comprehensive coverage, including inpatient hospital stays with a copay, outpatient services with coinsurance, and partial hospitalization with a copay. It also covers ambulance, emergency, and primary care services, along with preventive, hearing, vision, dental, and home infusion services. You can also expect to pay a copay for primary care visits, specialist visits, and various therapies.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For days 1-6, there is a $275 copay, and for days 7-90, there is no copay. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services and observation services with a 25% coinsurance and a service-specific out-of-pocket maximum of $1200.00, Ambulatory Surgical Center (ASC) Services with 25% coinsurance, outpatient substance abuse services with a $35 copay for individual and group sessions, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $35 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the PrimeTime Health Plan Basic - MA Only (HMO-POS) plan. Ground and Air Ambulance Services have a $200 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 the PrimeTime Health Plan Basic - MA Only (HMO-POS) plan. Emergency Services have a $140 copay, while Urgently Needed Services have a $60 copay; both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay, and Worldwide Emergency Transportation has a $200 copay; all have no coinsurance.
Primary Care See details
The PrimeTime Health Plan Basic - MA Only (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional visits, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, physician specialist services have a $40 copay, physical therapy and speech-language pathology services have a $35 copay, and other services have copays ranging from $35 to $40.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, Health Education, In-Home Safety Assessment, Fitness Benefit, Telemonitoring Services, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, but does not cover Annual Physical Exams, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing Services include routine hearing exams, with one visit covered every three years, and prescription hearing aids, with a copay between $595 and $895 for two hearing aids every three years. Fitting/evaluation for hearing aids, prescription hearing aids for inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
The PrimeTime Health Plan Basic - MA Only (HMO-POS) plan covers vision services, including routine eye exams with a $40 copay. Eyewear is covered with 20% coinsurance for contact lenses, and eyeglasses (lenses and frames) are covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $1,100 annual maximum. Medicare Dental Services have a $40 copay, and other services include oral exams, dental x-rays, other diagnostic dental services, cleaning, fluoride treatment, other preventive dental services, and restorative services, all of which are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services includes coverage for Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the PrimeTime Health Plan Basic - MA Only (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the PrimeTime Health Plan Basic plan, including Durable Medical Equipment (DME) with 20% coinsurance and no copay, and Prosthetics, Medical Supplies, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered, and Diabetic Supplies have 0-20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and outpatient X-ray services, are covered with a copay of $100, except for lab services which have no copay. Therapeutic Radiological Services are covered with a 20% coinsurance, and diagnostic radiological services have a copay of at most $250.
Home Health Services See details
Home Health Services are covered by the PrimeTime Health Plan Basic - MA Only (HMO-POS) plan with a $20 copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the PrimeTime Health Plan Basic - MA Only (HMO-POS) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, the copay is $20, for days 21-39 the copay is $150, and for days 40-100 there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items, with a maximum benefit of $75 every three months, and a meal benefit for chronic illness, but acupuncture, 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, 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. The plan also offers Nicotine Replacement Therapy (NRT) and Naloxone coverage as a Part C OTC benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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