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PrimeTime Health Plan Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PrimeTime Health Plan Plus (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 Plus (HMO-POS) in 2026, please refer to our full plan details page.
PrimeTime Health Plan Plus (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 Plus (HMO-POS) 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 PrimeTime Health Plan Plus (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 Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $115.00. 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 $4000.00 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 PrimeTime Health Plan Plus (HMO-POS) offers a budget-friendly prescription drug benefit with a $0 drug deductible, allowing your coverage to start immediately. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or standard mail order service. If you choose a standard pharmacy for these generic tiers, copays start at $8 for preferred generics and $10 for standard generics for a one-month supply. For higher-tier medications, Tier 3 preferred brand drugs require a $47 copay or 20% coinsurance, whichever is greater, across all pharmacy types. Tier 4 non-preferred drugs are subject to a 50% coinsurance, while Tier 5 specialty drugs carry a 33% coinsurance for a one-month supply. These structured cost-sharing tiers help you manage your out-of-pocket prescription expenses effectively throughout the year.
Additional Benefits
PrimeTime Health Plan Plus (HMO-POS) offers comprehensive medical coverage with no copay and no coinsurance for primary care doctor visits, while specialist visits require a $30 copay. For hospital services, inpatient stays require a $325 daily copay for the first six days and no copay thereafter, while outpatient hospital visits carry a $250 copay and 25% coinsurance. Emergency care is available with a $140 copay and no coinsurance, which is waived if you are admitted to the hospital within 23 hours. The plan also provides valuable supplemental coverage, including routine dental care up to a $1,250 annual limit and routine hearing exams with no copay and no coinsurance. Vision services feature a $30 copay for routine eye exams and a 20% coinsurance for covered eyewear like contact lenses. Additionally, members benefit from home health services and over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
PrimeTime Health Plan Plus (HMO-POS) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 and beyond. Unlimited additional days are covered under this plan, but prior authorization is required, and upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
PrimeTime Health Plan Plus (HMO-POS) covers outpatient hospital services with a $250 copay and 25% coinsurance, and ambulatory surgical center services with a $250 copay and no coinsurance. Outpatient substance abuse services require a $30 copay per session with no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
PrimeTime Health Plan Plus (HMO-POS) covers partial hospitalization services with a copay of either $30.00 or $35.00 and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
PrimeTime Health Plan Plus (HMO-POS) covers Medicare-approved ground and air ambulance services with a $200 copay and no coinsurance, subject to prior authorization requirements. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
PrimeTime Health Plan Plus (HMO-POS) covers emergency services with a $140 copay and urgently needed services with a $40 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 23 hours. Worldwide emergency and urgent services are 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 Plus (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits, mental health sessions, and physical therapies require a $30 copay and no coinsurance. Chiropractic care is covered with a $20 copay and no coinsurance, though routine chiropractic and podiatry services are not covered. Additional telehealth services are also available with a $0 to $30 copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by PrimeTime Health Plan Plus (HMO-POS) with no copay and no coinsurance for covered options like kidney disease education, fitness programs, and telemonitoring. Not covered services under this benefit include annual physical exams, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy-related hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, home safety modifications, and counseling.
Hearing Services See details
Hearing Services under PrimeTime Health Plan Plus (HMO-POS) are partially covered, offering one routine hearing exam and unlimited fitting evaluations annually with no copay and no coinsurance. Prescription hearing aids are covered for up to two devices per year with no coinsurance and a copay ranging from $499.00 to $999.00, though OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by PrimeTime Health Plan Plus (HMO-POS), featuring routine eye exams with a $30 copay and no coinsurance, and covered eyewear with no copay and a 20% coinsurance for contact lenses up to a $300 annual limit. There is no deductible for these services, but other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
PrimeTime Health Plan Plus (HMO-POS) covers Medicare dental services with a $30 copay and no coinsurance. Other preventive and comprehensive dental services, including cleanings, implants, and orthodontics, are covered with no copay and no coinsurance up to a $1,250 annual maximum, with prior authorization required for comprehensive services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by PrimeTime Health Plan Plus (HMO-POS) with no copay and no coinsurance, though associated Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance and no copay. Medicare Part B insulin is also covered under this benefit with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by PrimeTime Health Plan Plus (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
PrimeTime Health Plan Plus (HMO-POS) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic equipment, with no copay and a 20% coinsurance. Diabetic supplies offer a coinsurance ranging from no coinsurance up to 20%, and prior authorization is required for all of these covered services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the PrimeTime Health Plan Plus (HMO-POS), featuring prior authorization and no coinsurance for diagnostic services, which includes no copay for lab work and a $75 copay for diagnostic procedures. Radiological services are also covered, requiring a $50 copay for X-rays, a minimum $225 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are fully covered by PrimeTime Health Plan Plus (HMO-POS) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by PrimeTime Health Plan Plus (HMO-POS) with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
PrimeTime Health Plan Plus (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. There is no copay for days 1 to 20 and 46 to 100, a $200 copay for days 21 to 45, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
PrimeTime Health Plan Plus (HMO-POS) provides partial coverage for other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. While OTC items are covered up to $100 every three months, acupuncture is not covered under this plan.
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