2024 PrimeTime Health Plan Basic MA – Only (HMO-POS)

Basic MA- Only (HMO-POS)

No Rx coverage

$0 per month

$75 per month

You pay a $0 copay for each Medicare-covered PCP visit.

Telehealth available

AultmanNow Telehealth available

$40 copay for each Medicare-covered specialist 

Telehealth

AultmanNow Telehealth

$60 copay for Medicare-covered urgently-needed-care visits

$110 copay for Medicare-covered urgently-needed-care visits

$110 copay for Medicare-covered emergency room visits

$275 copay per day, days 1 – 6; then $0 copay per day for Medicare-covered hospital stays

25% of the cost for each Medicare-covered surgical service, annual out-of-pocket maximum cost of $1,200

$0 copay; Benefit is limited to 5 days, up to 10 meals, and following an inpatient or observation hospital stay with a doctor’s order.

$200 copay for Medicare-covered ambulance benefits

20% of the cost for Medicare-covered durable medical equipment

0% of cost for Medicare-covered diabetic testing supplies

20% of the cost for Medicare-covered diabetic supplies

$100 copay for Medicare-covered general diagnostic tests (not including x-rays)

$250 copay for Medicare-covered complex diagnostic radiology services (not including X-rays)

$100 copay for Medicare-covered X-ray services

$0-$35 copay for Medicare-covered lab services.

20% of the cost for Medicare-covered therapeutic radiology services

0%-20% of the cost for Medicare-covered Part B drugs

This plan does not include Part D Prescription Drug Coverage

$0 copay for all preventive services covered under Original Medicare at zero cost sharing.

$0 copay for the programs below:

• Tele-monitoring Services – Enrollees diagnosed with any of the conditions below may be eligible:
  • Heart Failure
  • Diabetes
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Hypertension
• Stroke Prevention Program – offered to members who have health conditions that put them at higher risk for stroke.
• Behavioral health program - this program provides support, education and resources for members with conditions such as depression, bipolar disorder, and substance use disorder.
• In-Home Safety Assessment -evaluates your home for potential safety concerns. For example: proper lighting, fall hazards, and grab bars. The benefit is available in our service area with the plan's contracted network.
• 24 Hour Nursing Hotline (330) 363-7600 or 1-855-409-6448 ‍
• The Silver&Fit® Exercise & Healthy Aging Program –offers members access to a fitness center membership at a participating fitness center or select YMCA at no additional cost.

Vision

$0 copay annual routine eye exam

$300 allowance for non-Medicare covered eyewear

$1,100 allowance for non-Medicare covered dental services

$0 copay for up to 40 hours per year of help with Instrumental Activities of Daily Living provided by Papa Pals.

$595 for a tier 1 hearing aid, $695 for a tier 2 hearing aid; and $895 for a tier 3 hearing aid. If you purchase a higher-tier hearing aid, your copay will be greater.

Hearing aids purchased from non-Amplifon providers are eligible for reimbursement of $100 per hearing aid.

Learn more about Amplifon

Up to $75 per quarter on qualified OTC items. You will receive a debit card with funds deposited quarterly to spend on OTC items and the flexibility to use the debit card at over 55,000 approved retail locations or order via the app, phone or mail for delivery directly to your home.

2024 Over-The-Counter (OTC) Brochure

$3,400