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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 2025, 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 2025.
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 $99.00. 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) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have an $8 copay at preferred pharmacies and a $16 copay at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. Note that the plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The PrimeTime Health Plan Plus (HMO-POS) plan offers comprehensive coverage, including inpatient hospital stays with a copay, and outpatient services with copays and coinsurance. The plan also covers emergency services, primary care, preventive services, and home health services. Additional benefits include hearing and vision coverage with copays and coinsurance, dental services with a yearly maximum, and medical equipment with coinsurance. The plan also provides coverage for skilled nursing facilities and other services like over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For days 1-6, you will pay a $285 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $200 copay and 25% coinsurance, Observation Services with 25% coinsurance, Ambulatory Surgical Center (ASC) Services with a $200 copay, and Outpatient Substance Abuse Services with a $30 copay for individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the PrimeTime Health Plan Plus (HMO-POS) plan, with a $35 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the PrimeTime Health Plan Plus (HMO-POS) plan. Ground and Air Ambulance Services have a $200 copay, while 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. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a $200 copay.
Primary Care See details
The PrimeTime Health Plan Plus (HMO-POS) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $30 copay, mental health specialty services with a $30 copay, psychiatric services with a $30 copay, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a $0-$30 copay, and opioid treatment program services with a $30 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, health education, in-home safety assessments, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following a Welcome Visit, and fitness benefits, with no copay. Annual physical exams, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers, additional sessions of smoking cessation counseling, enhanced disease management, home and bathroom safety devices, and counseling services are not covered. In-home support services, telemonitoring services, and remote access technologies are covered.
Hearing Services See details
Hearing Services includes coverage for routine hearing exams with one visit every three years, and prescription hearing aids with a copay between $595 and $895 for two hearing aids every three years; however, fitting/evaluation, OTC hearing aids, and prescription hearing aids (inner ear, outer ear, and over the ear) are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $30 copay, and eyewear including contact lenses and eyeglasses (lenses and frames). Eyewear has a 20% coinsurance and a combined maximum benefit of $300 per year, and eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, as well as other dental services, with a yearly maximum of $1250. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are all covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the PrimeTime Health Plan Plus (HMO-POS) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the PrimeTime Health Plan Plus (HMO-POS) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits are covered by PrimeTime Health Plan Plus (HMO-POS). Durable Medical Equipment has a 20% coinsurance, and requires authorization. Prosthetics/Medical Supplies has a 20% coinsurance. Diabetic Supplies have between 0% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with an $85 copay, lab services with no copay, and outpatient X-ray services with a $50 copay. Diagnostic Radiological Services have a copay of at least $225, and Therapeutic Radiological Services have at least 20% coinsurance.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PrimeTime Health Plan Plus (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, for days 21-45 the copay is $120, and for days 46-100, there is no copay. Additional days beyond Medicare and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The PrimeTime Health Plan Plus (HMO-POS) plan covers Over-the-Counter (OTC) Items, with a maximum benefit of $100 every three months, and Meal Benefits for chronic illness. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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