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PrimeTime Health Plan Aultimate (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PrimeTime Health Plan Aultimate (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 Aultimate (HMO-POS) in 2026, please refer to our full plan details page.
PrimeTime Health Plan Aultimate (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 Aultimate (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 Aultimate (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 Aultimate (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.
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 $270.00 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 $4900.00 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 Aultimate (HMO-POS) prescription drug plan features an annual drug deductible of $270. You will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or standard mail order. For Tier 2 generic drugs, copayments start at $8 for a one-month supply at preferred pharmacies and standard mail order, compared to a $15 copay at standard pharmacies. Higher-tier medications under this plan are subject to coinsurance costs instead of flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 40% coinsurance. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply at preferred, standard, and standard mail-order pharmacies.
Additional Benefits
The PrimeTime Health Plan Aultimate (HMO-POS) offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits and home health services. For inpatient hospital stays, members pay a daily copay of $385 for days one through six and no copay for subsequent days, with no coinsurance. Outpatient surgeries, specialist visits, and emergency services are also covered with fixed copays and no coinsurance, helping you manage your healthcare budget. This plan also provides valuable extra benefits, including preventive and comprehensive dental care with no copay up to a $600 annual limit. Routine vision exams require a $40 copay, while routine hearing exams have a $25 copay with no coinsurance or deductibles. Additionally, members receive a $50 quarterly over-the-counter allowance and medical equipment coverage with no copays and a 20% coinsurance.
Inpatient Hospital See details
PrimeTime Health Plan Aultimate (HMO-POS) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $385 daily copay for days 1 through 6 and no copay for days 7 and beyond. Prior authorization is required, and while additional benefit days are unlimited, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
PrimeTime Health Plan Aultimate (HMO-POS) covers outpatient hospital and ambulatory surgical center services with a $350 copay, featuring a 25% coinsurance for hospital and observation services but no coinsurance for surgical center services. Outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the PrimeTime Health Plan Aultimate (HMO-POS) with a copay of $40.00 or $55.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
PrimeTime Health Plan Aultimate (HMO-POS) covers ground and air ambulance services with a $230 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
PrimeTime Health Plan Aultimate (HMO-POS) covers emergency services with a $130 copay and urgent care with a $40 copay, both featuring no coinsurance and waived if admitted to the hospital within 23 hours. Worldwide emergency and urgent services are also covered with a $130 copay, while worldwide emergency transportation is covered with a $230 copay, both with no coinsurance.
Primary Care See details
PrimeTime Health Plan Aultimate (HMO-POS) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Physical and occupational therapy require a $45 copay, mental health, psychiatric, and opioid treatment services have a $40 copay, and telehealth ranges from a $0 to $40 copay, all with no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine and other chiropractic services, while podiatry services are not covered.
Preventive Services See details
PrimeTime Health Plan Aultimate (HMO-POS) offers partial coverage for preventive services with no copay and no coinsurance, including Medicare-covered zero-dollar services, kidney disease education, diabetes self-management, and fitness benefits. Some services are not covered, such as annual physical exams, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
PrimeTime Health Plan Aultimate (HMO-POS) hearing services are partially covered, offering routine hearing exams for a $25 copay and no coinsurance, with no deductible. Prescription hearing aids are covered with a copay ranging from $499 to $999 and no coinsurance for up to two aids 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 Aultimate (HMO-POS) covers routine eye exams with a $40 copay, no coinsurance, and no deductible, plus eyewear with no copay, no deductible, and 20% coinsurance for contact lenses up to a $300 annual maximum. This benefit is partially covered, as other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
PrimeTime Health Plan Aultimate (HMO-POS) covers Medicare-covered dental services with a $40 copay and no coinsurance. Other preventive and comprehensive dental services, including exams, cleanings, and implants, are covered with no copay and no coinsurance up to a maximum plan benefit of $600 every year, though prior authorization is required for comprehensive services.
Home Infusion bundled Services See details
PrimeTime Health Plan Aultimate (HMO-POS) covers Home Infusion bundled Services with no copay, and Medicare Part B insulin drugs with a $35 copay and no coinsurance. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by PrimeTime Health Plan Aultimate (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by PrimeTime Health Plan Aultimate (HMO-POS) with no copays, though prior authorization is required for these services. Covered items—including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes—carry a 20% coinsurance, while diabetic supplies range from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
PrimeTime Health Plan Aultimate (HMO-POS) diagnostic and radiological services are partially covered, as lab services are not covered. Covered diagnostic procedures require a $125 copay with no coinsurance, while radiological benefits include outpatient X-rays for a $50 copay plus coinsurance, diagnostic radiology for a minimum $250 copay with no coinsurance, and therapeutic radiology with a copay and 20% minimum coinsurance.
Home Health Services See details
Home Health Services are covered by PrimeTime Health Plan Aultimate (HMO-POS) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the PrimeTime Health Plan Aultimate (HMO-POS) with no copay and no coinsurance, subject to prior authorization. While some services are covered, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by PrimeTime Health Plan Aultimate (HMO-POS) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and days 46 through 100, a $215 daily copay for days 21 through 45, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
PrimeTime Health Plan Aultimate (HMO-POS) partially covers other services, providing a meal benefit for chronic illness and a quarterly $50 over-the-counter (OTC) allowance, both with no copay and no coinsurance. Acupuncture is not covered under this plan.
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