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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 2026, 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 2026.
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) offers affordable access to essential medical care, featuring no copay for primary care visits and a $40 copay for specialists. Inpatient hospital stays require a $275 daily copay for the first six days and no copay thereafter, while emergency room visits have a $140 copay. Outpatient hospital services generally carry a 25% coinsurance with no copay, making core medical costs highly predictable. This plan also provides robust coverage for supplemental health needs, including dental care with no copay up to an annual limit of $1,100 and no-copay routine hearing exams. Members benefit from a $75 quarterly over-the-counter allowance, no-copay preventive services like fitness benefits, and vision care with a $40 copay for routine annual exams. Most covered services, including diagnostic labs and home health care, feature low copays and no coinsurance, helping you manage your healthcare budget effectively.
Inpatient Hospital See details
PrimeTime Health Plan Basic - MA Only (HMO-POS) partially covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $275 daily copay for days 1 through 6 and no copay for days 7 and beyond. Prior authorization is required for these stays, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by PrimeTime Health Plan Basic - MA Only (HMO-POS), with outpatient hospital, observation, and ambulatory surgical center services requiring a 25% coinsurance and no copay. Outpatient substance abuse sessions require a $35 copay and no coinsurance, while outpatient blood services are available with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
PrimeTime Health Plan Basic - MA Only (HMO-POS) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
PrimeTime Health Plan Basic - MA Only (HMO-POS) covers Medicare-covered ground and air ambulance services with a $200 copay, no coinsurance, and prior authorization required. For transportation services, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
PrimeTime Health Plan Basic - MA Only (HMO-POS) covers emergency services with a $140 copay and urgently needed services with a $60 copay, both featuring no coinsurance. Worldwide emergency and urgent services are also covered with a $140 copay, and worldwide emergency transportation is covered with a $200 copay, all with no coinsurance.
Primary Care See details
PrimeTime Health Plan Basic - MA Only (HMO-POS) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Physical, occupational, speech, and mental health therapies are covered with a $35 copay and no coinsurance, but podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by PrimeTime Health Plan Basic - MA Only (HMO-POS) with no copay and no coinsurance for covered services like fitness benefits, telemonitoring, and kidney disease education. Uncovered sub-services include annual physical exams, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, home and bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by PrimeTime Health Plan Basic - MA Only (HMO-POS), featuring one annual routine exam and unlimited fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids per year are covered with a copay ranging from $499 to $999 and no coinsurance, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
PrimeTime Health Plan Basic - MA Only (HMO-POS) vision services are partially covered, featuring a $40 copay, no coinsurance, and no deductible for one routine annual eye exam, while other eye exam services are not covered. Eyewear is also partially covered with no copay, no deductible, and a 20% coinsurance for contact lenses up to a $300 yearly limit, though eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
PrimeTime Health Plan Basic - MA Only (HMO-POS) covers Medicare-covered dental services with a $40 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance up to an annual maximum of $1,100. Prior authorization is required for Medicare dental services and comprehensive treatments like restorative, endodontic, periodontic, and orthodontic care.
Home Infusion bundled Services See details
PrimeTime Health Plan Basic - MA Only (HMO-POS) covers home infusion bundled services with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance. Medicare Part B insulin is also covered under this benefit with a $35 copay and no coinsurance.
Dialysis Services See details
PrimeTime Health Plan Basic - MA Only (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
PrimeTime Health Plan Basic - MA Only (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, and diabetic services, with no copay and generally a 20% coinsurance. Diabetic supplies feature a coinsurance ranging from no coinsurance to 20%, and prior authorization is required for all covered equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by PrimeTime Health Plan Basic - MA Only (HMO-POS), featuring a $100 copay and no coinsurance for diagnostic tests, and no copay or coinsurance for lab services. Diagnostic radiological services require a minimum $250 copay with no coinsurance, while outpatient X-rays incur a $100 copay plus coinsurance, and therapeutic radiology requires a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by PrimeTime Health Plan Basic - MA Only (HMO-POS) with a $20.00 copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under PrimeTime Health Plan Basic - MA Only (HMO-POS) with no copay and no coinsurance, subject to prior authorization. However, only some services are covered in practice, as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
PrimeTime Health Plan Basic - MA Only (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, as additional days beyond the Medicare-covered limit are not covered. Prior authorization is required, and patients pay a $20 daily copay for days 1 to 20, a $150 daily copay for days 21 to 39, and no copay for days 40 to 100.
Other Services See details
PrimeTime Health Plan Basic - MA Only (HMO-POS) partially covers other services, offering chronic illness meal benefits and an over-the-counter (OTC) allowance of $75 every three months with no copay and no coinsurance. Acupuncture is not covered under this plan.
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