A non-government entity
PrimeTime Health Plan Classic (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PrimeTime Health Plan Classic (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 Classic (HMO-POS) in 2025, please refer to our full plan details page.
PrimeTime Health Plan Classic (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 Classic (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 Classic (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 Classic (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $45.00. 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 $4100.00 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:
Sign up for PrimeTime Health Plan Classic (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The PrimeTime Health Plan Classic (HMO-POS) has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In 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, while standard generic drugs have a $47 copay or 20% coinsurance (whichever is greater). After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The PrimeTime Health Plan Classic (HMO-POS) offers a range of benefits with varying cost-sharing. The plan covers inpatient hospital stays with a $375 copay for the first six days, and no copay thereafter. Outpatient services, including doctor visits, have copays ranging from $20 to $300, and some services, like blood work, have no copay. The plan provides coverage for emergency services with a $140 copay, and also includes benefits for hearing, vision, and dental care. Hearing exams have a $5 copay, and routine eye exams have a $35 copay, while dental services have a $35 copay for Medicare-covered services. Additionally, the plan offers coverage for home health services, with no copay, and home infusion services with a $35 copay for some drugs.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization, and have a copay of $375 for days 1-6, and no copay for days 7-90. Additional days for both are covered, while Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a $300 copay and 25% coinsurance, observation services with 25% coinsurance, ambulatory surgical center services with a $300 copay, and outpatient substance abuse services with a copay of $35 for both individual and group sessions. Outpatient blood services are also covered, with a waived deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered by the PrimeTime Health Plan Classic (HMO-POS) with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by PrimeTime Health Plan Classic (HMO-POS). Ground and Air Ambulance Services have a $210 copay with no coinsurance, 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 under the PrimeTime Health Plan Classic (HMO-POS). Emergency Services have a $140 copay, and Urgently Needed Services have a $40 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay and Worldwide Emergency Transportation has a $210 copay. There is no coinsurance for any of these services.
Primary Care See details
The PrimeTime Health Plan Classic (HMO-POS) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $35 copay, mental health and psychiatric services with a $35 copay, physical therapy and speech-language pathology services with a $40 copay, and opioid treatment program services with a $35 copay. The plan also offers additional telehealth benefits with copays ranging from $0 to $35.
Preventive Services See details
The PrimeTime Health Plan Classic (HMO-POS) plan covers preventive services including health education, in-home safety assessments, fitness benefits, telemonitoring services, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits. Annual physical exams, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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 and tobacco cessation counseling, enhanced disease management, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams, which have a $5 copay, with Routine Hearing Exams covered once every three years, and Fitting/Evaluation for Hearing Aid not covered. Prescription hearing aids are covered, with a copay between $595 and $895 for Prescription Hearing Aids (all types), while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with a $35 copay, and eyewear with 20% coinsurance for contact lenses. Eyeglasses (lenses and frames) are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $35 copay, and other dental services with a $900 maximum benefit per year. The plan covers 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.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, are covered by PrimeTime Health Plan Classic (HMO-POS). For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the PrimeTime Health Plan Classic (HMO-POS). You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay of $105, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $240, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the PrimeTime Health Plan Classic (HMO-POS) 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 technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay; for days 21-45, the copay is $135, and for days 46-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with a maximum benefit of $100 every three months, and a meal benefit for chronic illness, but does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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, or Self-Directed Personal Assistance Services.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved