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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 2025, 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 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4300.00 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) plan has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $12 copay at preferred pharmacies, and 50% coinsurance for preferred brand drugs. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The PrimeTime Health Plan Aultimate (HMO-POS) plan offers comprehensive coverage with a variety of benefits. Inpatient hospital stays have a $310 copay for the first six days, with no copay for the remainder of the stay, while outpatient services have varying copays and coinsurance depending on the service. This plan also includes coverage for ambulance services, emergency services, primary care, and preventive services, often with copays. Additional benefits include hearing exams and hearing aids, vision exams and eyewear, dental services, and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-6, there is a $310 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $350 copay and 25% coinsurance, Observation Services with 25% coinsurance, Ambulatory Surgical Center (ASC) Services with a $350 copay, and Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions. Outpatient Blood Services are also covered with a waived three (3) pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the PrimeTime Health Plan Aultimate (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 Aultimate (HMO-POS). Ground and air ambulance services have a $230 copay, and there is no coinsurance. 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 $110 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Transportation has a $230 copay; all have no coinsurance. Worldwide Urgent Coverage has a $110 copay and no coinsurance.
Primary Care See details
The PrimeTime Health Plan Aultimate (HMO-POS) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy with a $45 copay, physician specialist services with a $40 copay, mental health specialty services with a $40 copay, physical therapy and speech-language pathology services with a $45 copay, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $40 copay; however, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as additional services like Health Education, In-Home Safety Assessment, Fitness Benefit, Telemonitoring Services, and Remote Access Technologies. However, this plan does not cover Annual Physical Exams, Personal Emergency Response Systems, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Home and Bathroom Safety Devices and Modifications, or Counseling Services.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $25 copay, limited to one exam every three years, as well as prescription hearing aids (all types) with a copay between $595 and $895, limited to two aids every three years. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a $40 copay, and eyewear, with a 20% coinsurance for contact lenses. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The PrimeTime Health Plan Aultimate (HMO-POS) plan covers dental services, including oral exams with a $40 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services. The plan also covers orthodontic services and other services with a maximum benefit of $900 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies has a 20% coinsurance for Medicare-covered items, and Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a $125 copay, and Diagnostic Radiological Services with a $250 copay. Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the PrimeTime Health Plan Aultimate (HMO-POS) with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PrimeTime Health Plan Aultimate (HMO-POS) plan, but require prior authorization. You will have no copay for days 1-20, a $150 copay for days 21-45, and no copay for days 46-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items and Meal Benefits; however, 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, and Self-Directed Personal Assistance Services are not covered. The plan provides up to $100 every three months for OTC items, and also covers a meal benefit for chronic illnesses.
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