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Univera Medicare Total Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Univera Medicare Total Care (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 Total Care (HMO D-SNP) in 2025, please refer to our full plan details page.
Univera Medicare Total Care (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 2025.
It's important to know that Univera Medicare Total Care (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 Total Care (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 Total Care (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 Total Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $41.10. 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 $590.00 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 $9350.00 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 Total Care (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. After the deductible, you will pay either a copay or coinsurance for your prescriptions. For example, you will pay a $20 copay for preferred generic drugs at a standard or mail order pharmacy. For preferred brand drugs, you pay 35% coinsurance.
Additional Benefits
The Univera Medicare Total Care (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay for the first few days, then no copay for the remainder, while outpatient services and emergency services have a 20% coinsurance. Many services, including primary care, preventive services, hearing and vision services, and dental, are covered with a coinsurance, and some services like home health and skilled nursing facilities have copays or no cost. This plan provides additional benefits such as coverage for home infusion, dialysis, medical equipment, and diagnostic services, all with a coinsurance. The plan also includes an over-the-counter (OTC) benefit with a monthly allowance. However, it's important to note that some services like cardiac rehabilitation and certain types of eyewear are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $400 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $374 copay for days 1-5, and no copay for days 6-90. Additional days, and non-Medicare covered stays for both are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital and observation services have a 20% coinsurance, and outpatient substance abuse services (individual and group sessions) have a 20% coinsurance. Outpatient blood services include an enhanced benefit.
Partial Hospitalization See details
Partial Hospitalization is covered by the Univera Medicare Total Care (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a 20% coinsurance, and there is no copay. 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 Univera Medicare Total Care (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services have a 20% coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Univera Medicare Total Care (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, and physical therapy and speech-language pathology services have a 20% coinsurance. Individual and group mental health and psychiatric sessions have a 20% coinsurance. Occupational therapy services and opioid treatment program services have a minimum and maximum coinsurance of 20%. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered. Other preventive services are covered with 20% coinsurance for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services includes coverage for routine hearing exams with a coinsurance of at most 20%, and fitting/evaluation for hearing aids with no coinsurance. Prescription hearing aids are partially covered, but does not cover inner ear, outer ear, or over the ear hearing aids. OTC hearing aids are not covered.
Vision Services See details
The Univera Medicare Total Care (HMO D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are limited to one per year. Eyewear, including contact lenses, also has a 20% coinsurance with a combined maximum benefit of $200 per year, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Univera Medicare Total Care (HMO D-SNP) plan covers dental services with 20% coinsurance for Medicare dental services. Oral exams, prophylaxis (cleaning), and fluoride treatments are limited to one visit every six months. Dental X-rays, other diagnostic dental services, 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 are covered with prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Univera Medicare Total Care (HMO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay with coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Univera Medicare Total Care (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with 20% coinsurance for covered supplies, but Durable Medical Equipment for use outside the home is not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic procedures and tests with a coinsurance of at most 20%, while lab services are not covered. Radiological Services are covered, with no copay and a coinsurance of at most 20% for diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered by the Univera Medicare Total Care (HMO D-SNP) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Univera Medicare Total Care (HMO D-SNP) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Univera Medicare Total Care (HMO D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Univera Medicare Total Care (HMO D-SNP) plan covers Over-the-Counter (OTC) items, with a maximum benefit of $75.00 every month, and Nicotine Replacement Therapy (NRT) is included as a Part C OTC benefit. However, acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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