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Univera Medicare Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Univera Medicare Dual (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Univera Medicare Dual (HMO D-SNP) in 2026, please refer to our full plan details page.
Univera Medicare Dual (HMO D-SNP) is a HMO D-SNP plan offered by Lifetime Healthcare, Inc. available for enrollment in 2025 to people living in Western New York. The overall rating for this plan is not yet available for 2026.
It's important to know that Univera Medicare Dual (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Univera Medicare Dual (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Univera Medicare Dual (HMO D-SNP).
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 Univera Medicare Dual (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.80. 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 $615.00 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 $9250.00 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 Univera Medicare Dual (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. You will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic drugs, copays start at $20 for a one-month supply, while Tier 3 preferred brand drugs require a $47 copay for a one-month supply. For higher-tier medications, Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance for one-month, two-month, and three-month supplies. This coinsurance rate applies to both standard retail pharmacies and standard mail-order services. These clear copayment and coinsurance structures help you easily project your out-of-pocket costs for prescription medications.
Additional Benefits
The Univera Medicare Dual (HMO D-SNP) plan offers comprehensive coverage where most outpatient services, primary care visits, emergency care, and medical equipment require no copay and a standard 20% coinsurance. For inpatient hospital stays, members pay a daily copay for the first five days and no copay for days six through ninety, with no coinsurance required. Skilled nursing facility stays similarly require no coinsurance, featuring no copay for the first 20 days followed by a daily copay for days 21 through 100. Many vital benefits are covered with no copay and no coinsurance, including home health services, telehealth visits, preventive dental care, and up to two prescription hearing aids per year. Routine vision and hearing exams generally require a 20% coinsurance and no copay, and the plan provides a $200 annual allowance for eyewear alongside a $65 monthly allowance for over-the-counter items. This plan combines key medical and supplemental benefits to deliver affordable healthcare coverage with clear, predictable costs.
Inpatient Hospital See details
Univera Medicare Dual (HMO D-SNP) offers partially covered inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Acute stays require a $475 daily copay for days 1 through 5 and no copay for days 6 through 90, while psychiatric stays incur a $374 daily copay for days 1 through 5 and no copay for days 6 through 90; however, additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Univera Medicare Dual (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Univera Medicare Dual (HMO D-SNP) covers partial hospitalization with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Univera Medicare Dual (HMO D-SNP), which features ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. However, transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Univera Medicare Dual (HMO D-SNP) covers emergency, urgently needed, and worldwide emergency services with no copay and a 20% coinsurance. The emergency services coinsurance is waived if you are admitted to the hospital within 23 hours.
Primary Care See details
Primary Care benefits under the Univera Medicare Dual (HMO D-SNP) plan cover primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance, while telehealth services feature no copay and no coinsurance. Podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by Univera Medicare Dual (HMO D-SNP), offering annual physical exams, kidney disease education, memory fitness, and remote access technologies with no copay and no coinsurance. Other services like glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs require a 20% coinsurance and no copay, while several supplemental benefits including health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by Univera Medicare Dual (HMO D-SNP), offering one routine hearing exam per year with no copay, a 20% coinsurance, and no deductible, alongside unlimited hearing aid fittings with no copay. Up to two prescription hearing aids are covered annually with no copay or coinsurance, but OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Univera Medicare Dual (HMO D-SNP) with no copays or deductibles, though a 20% coinsurance applies to routine eye exams and contact lenses. The plan covers one routine eye exam per year and provides a $200 annual limit for eyeglasses and contact lenses, but other eye exams, individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Univera Medicare Dual (HMO D-SNP) offers dental services with no copay and a 20% coinsurance for Medicare-covered dental care. Other dental services, including preventive cleanings, exams, x-rays, and comprehensive treatments like orthodontics and periodontics, are covered with no copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered under Univera Medicare Dual (HMO D-SNP) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Medicare Part B chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Univera Medicare Dual (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Univera Medicare Dual (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with no copay and 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Univera Medicare Dual (HMO D-SNP), as lab services are not covered. Covered services, including diagnostic procedures, radiological services, and outpatient X-rays, require prior authorization and feature no copay and a minimum 20% coinsurance.
Home Health Services See details
Univera Medicare Dual (HMO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Univera Medicare Dual (HMO D-SNP) covers some cardiac rehabilitation services with no copay, but several sub-services are not covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Univera Medicare Dual (HMO D-SNP) with no coinsurance, though prior authorization is required and a prior three-day hospital stay is not. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Univera Medicare Dual (HMO D-SNP) partially covers other services, offering chronic illness meals and up to $65 per month for over-the-counter items with no copay and no coinsurance. Acupuncture, highly integrated dual-eligible SNP services, and other additional services are not covered.
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