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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 2026, 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 2026.
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 $60.00. 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 a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4500.00 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 Classic (HMO-POS) features an annual drug deductible of $200. Under this plan, Tier 1 preferred generic drugs have no copay when filled at preferred pharmacies or through standard mail order. Tier 2 generic drugs are also highly affordable, starting at a $6 copay for a one-month supply at preferred pharmacies and standard mail order. For higher-tier medications, the plan utilizes coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 40% coinsurance at both standard and preferred locations. Specialty drugs in Tier 5 have a 30% coinsurance for a one-month supply.
Additional Benefits
The PrimeTime Health Plan Classic (HMO-POS) offers comprehensive medical coverage featuring no copay for primary care doctor visits, preventive services, and home health care. For specialized care, members pay a $35 copay for specialists and a $130 copay for emergency room visits. Inpatient hospital stays require a $375 daily copay for the first six days, after which there is no copay for days seven through ninety. This plan also includes valuable dental, vision, and hearing benefits to help reduce your out-of-pocket costs. Routine dental services are covered with no copay up to a $1,000 annual limit, while routine hearing exams carry a low $5 copay. Additionally, members can take advantage of an over-the-counter benefit of up to $100 every three months with no copay.
Inpatient Hospital See details
PrimeTime Health Plan Classic (HMO-POS) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring prior authorization and a $375 daily copay for days 1 through 6, followed by no copay for days 7 through 90. While unlimited additional days are covered, upgrades and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
PrimeTime Health Plan Classic (HMO-POS) covers outpatient hospital services with a $300 copay and 25% coinsurance, and ambulatory surgical center services with a $300 copay and no coinsurance. Outpatient substance abuse services are covered with a $35 copay and no coinsurance, while outpatient blood services require no copay and no coinsurance.
Partial Hospitalization See details
PrimeTime Health Plan Classic (HMO-POS) covers partial hospitalization services with a copay of either $35.00 or $55.00 and no coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
PrimeTime Health Plan Classic (HMO-POS) covers ground and air ambulance services with a $210 copay and no coinsurance, though prior authorization is required. For transportation benefits, 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 Classic (HMO-POS) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 23 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency and urgent care carry a $130 copay and worldwide emergency transportation has a $210 copay, all with no coinsurance.
Primary Care See details
PrimeTime Health Plan Classic (HMO-POS) offers partially covered primary care benefits, featuring no copay and no coinsurance for primary care physician visits, and a $35 copay with no coinsurance for specialists, psychiatric, and mental health services. Physical, occupational, and speech therapies require a $40 copay with no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
PrimeTime Health Plan Classic (HMO-POS) covers preventive services, kidney disease education, and screenings with no copay and no coinsurance. While additional benefits like fitness programs and telemonitoring are included, other services such as annual physical exams, personal emergency response systems (PERS), and weight management programs are not covered.
Hearing Services See details
PrimeTime Health Plan Classic (HMO-POS) covers annual routine hearing exams with a $5.00 copay and no coinsurance, as well as unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $499.00 to $999.00 for up to two devices per year, though OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
PrimeTime Health Plan Classic (HMO-POS) covers routine eye exams with a $35 copay and no coinsurance, though other eye exam services are not covered. Eyewear is partially covered with no copay and a 20% coinsurance for contact lenses up to a $300 annual maximum, but separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered by PrimeTime Health Plan Classic (HMO-POS), featuring a $35 copay and no coinsurance for Medicare-covered care. Other preventive and comprehensive dental services have no copay and no coinsurance up to a $1,000 annual maximum, though prior authorization is required for comprehensive care.
Home Infusion bundled Services See details
PrimeTime Health Plan Classic (HMO-POS) covers home infusion bundled services with no copay, although associated Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance ranging from 0% to 20%. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by PrimeTime Health Plan Classic (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by PrimeTime Health Plan Classic (HMO-POS) with no copays, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic shoes carry a 20% coinsurance, while diabetic supplies feature a coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the PrimeTime Health Plan Classic (HMO-POS) with prior authorization required for diagnostic services. Diagnostic tests require a $105 copay with no coinsurance, lab services have no copay, diagnostic radiology starts at a $240 copay, outpatient X-rays have a $50 copay, and therapeutic radiology has a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by PrimeTime Health Plan Classic (HMO-POS) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
PrimeTime Health Plan Classic (HMO-POS) offers coverage for some cardiac rehabilitation services with no copay and no coinsurance, subject to prior authorization. However, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
PrimeTime Health Plan Classic (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1–20 and 46–100, and a $200 daily copay for days 21–45. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under the PrimeTime Health Plan Classic (HMO-POS) are partially covered, featuring a chronic illness meal benefit and an over-the-counter (OTC) benefit of up to $100 every three months with no copay and no coinsurance. Acupuncture is not covered under this plan.
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