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Aultimate

Aultimate

Choosing PrimeTime Health Plan

We believe that people choose PrimeTime Health Plan because of our person-to-person service, affordability, and clinical care coordination team. Our members are like our family. Whether they call or stop by our offices, the PrimeTime Team is always ready to talk with them and help them understand their Medicare choices. PrimeTime Health Plan is a Medicare Advantage Organization with a Medicare contract. Enrollment in Medicare Advantage plans depends on contract renewal.

Since 1997, PrimeTime Health Plan has been available to Medicare eligible individuals in the local communities we serve. Founded on the values of affordable pricing and service excellence. We serve: Carroll, Columbiana, Harrison, Holmes, Mahoning, Medina, Portage, Stark, Summit, Trumbull, Tuscarawas, and Wayne counties.

Our Promise to You: When you call, someone will pick up. Your claims will be processed quickly. Your questions will be answered. And we’re always searching for the better way to do things for you.

Learn more about our 5-Star Rating and Quality Recognition.

 

Local, Affordable Service Makes a Difference

PrimeTime Health Plan Members Receive:

  • Affordable, cost-effective premiums
  • HMO-POS Plans with and without Part D prescription coverage
  • Unlimited lifetime coverage
  • Worldwide coverage for emergent care
  • Outstanding personal customer service
  • A dedicated team that's here for you

 

 

Eligibility Requirements - Aultimate Plan

You are eligible for membership in our Medicare Advantage plan as long as:

  1. You live in our service area: Carroll, Columbiana, Harrison, Holmes, Mahoning, Medina, Portage, Stark, Summit, Trumbull, Tuscarawas, and Wayne Counties --and--
  2. you have both Medicare Part A and Medicare Part B (When you enroll in a Medicare Advantage Plan, you continue to pay your Medicare Part B premium.) --and--
  3. you are a United States citizen or are lawfully present in the United States

Ways to Enroll - Aultimate Plan

People may enroll in the plan only during specific times of the year. Contact PrimeTime Health Plan for more information. If you have questions or require language assistance, please call Customer Service at 330-363-7407 or 1-800-577-5084. For people who are hearing impaired, please call our TTY line at 711. Interpreter services are provided free of charge to you. A customer service representative is available to assist you Monday through Friday from 8:00 a.m. to 8:00 p.m. (October 1st – March 31st, we are available 7 days a week, 8:00 a.m. to 8:00 p.m.)

ONLINE

Beginning October 15, 2021, you can complete a secure online enrollment application by continuing with the green button below.

  • $0 Monthly Premium
  • $0 Annual Deductible
  • $4,500 Annual Out-of-Pocket Max

You will get an enrollment packet in the mail from PrimeTime Health Plan within seven to ten calendar days of enrolling online.


IN PERSON

You can visit us during our office hours Monday through Friday from 8:00 a.m. to 4:30 p.m. to drop off your completed enrollment application. Additionally, a PrimeTime Health Plan staff person is available to meet with you to discuss your plan options. You can complete an enrollment application during this appointment or take one with you to fill out and return. To schedule an appointment, please call 330-363-7407 or 1-800-577-5084. TTY users call 711. Our call center is available Monday through Friday from 8:00 a.m. to 8:00 p.m. (October 1st – March 31st, we are available 7 days a week, 8:00 a.m. to 8:00 p.m.).

PrimeTime Health Plan

Morrow House

2600 Sixth St SW

Canton, Ohio 44710

 

Download the application form (PDF)


BY MAIL

You can also choose to print and complete an enrollment application. When completed, mail the enrollment application to our office at:

PrimeTime Health Plan

Morrow House 2600 Sixth St SW

Canton, Ohio 44710

 

Download the application form (PDF)

Summary of Benefits - Aultimate

Benefit category

Aultimate (HMO-POS)

Plan Premium

$0 per month

Primary Care Physician

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

Telehealth available

Teladoc® available

Specialist

$40 copay for each Medicare-covered specialist visit Telehealth available

Urgent Care (Inside United States)

$65 copay for Medicare-covered urgently-needed-care visits

Urgent Care (Outside United States)

$90 copay for Medicare-covered urgently-needed-care visits

Emergency Care (Worldwide Coverage)

$90 copay for Medicare-covered emergency room visits

Inpatient Hospital Coverage

$310 copay per day, days 1 – 6; then $0 copay per day for Medicare-covered hospital stays

Outpatient Surgery (Ambulatory/Outpatient Surgery)

$350 copay for each Medicare-covered surgical visit

Home Delivered Meal Benefit

$0 copay; Benefit is limited to 5 days, up to 10 meals, and following an inpatient hospital stay at a network facility.

Ambulance Services

$230 copay for Medicare-covered ambulance benefits

Durable Medical Equipment

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

Diabetic Testing Supplies (test strips, lancets, certain glucometers) 0% of cost for Medicare-covered diabetic testing supplies

Other Diabetic Supplies 20% of the cost for Medicare-covered diabetic supplies

Diagnostic Tests and Procedures

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

Diagnostic Radiology Services (MRI/CT/PET/Thallium Scans)

$190 copay for Medicare-covered complex diagnostic radiology services (not including X-rays)

Outpatient X-rays

$100 copay for Medicare-covered X-ray services

Lab Services

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

Radiation Therapy

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

Part B Prescription and Chemotherapy Drugs

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

Preventive Services

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

Health & Wellness Education Programs

$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)
    • Behavioral Health Conditions
  • Stroke Prevention Program – offered to members who have health conditions that put them at higher risk for stroke.
  • 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.

Supplemental Vision and Dental

Reimbursement up to $300 annually combined for non-Medicare-covered dental and vision costs.

You pay a copayment of $595, $695, or $895 per hearing aid depending on the brand and model selected.

Out of Pocket Maximum (per calendar year)

$3,400

Part D Prescription Drug Coverage

Cost-sharing may change when you enter a new stage of the Part D benefit. For more information on the stages of the benefit, please contact the plan or view the Evidence of Coverage online at www.pthp.com.

Phase 1: Deductible Stage*: You must pay the full cost of your Tier 3, Tier 4, and Tier 5 drugs until you have paid the deductible. The amount of the deductible is listed in the chart below. For drugs in Tier 1, Tier 2, or the Insulin Savings Program you do not pay a deductible and will receive coverage immediately at the copay amount listed below.

Phase 2: Initial Coverage Stage During this stage, the plan pays its share of the cost of your generic drugs and you pay your share of the cost. After you (or others on your behalf) have met your Tiers 3, 4, and 5 deductible, the plan pays its share of the costs of your Tiers 3, 4, and 5 drugs and you pay your share. You pay the following copays/coinsurance until your total yearly drug costs reach $4,430. Total yearly drug costs are the total drug costs paid by both you and our Part D plan.

The below copays/coinsurance are for prescriptions purchased from network pharmacies. Costs will differ based on whether the prescriptions are filled at a preferred pharmacy, standard pharmacy, or mail order pharmacy. Refer to your pharmacy directory for information on which pharmacies are preferred or standard. Cost will also differ based on the number of days’ supply. Long-Term Care (LTC) pharmacies can fill up to a 31-day supply at the 30-day copays/ coinsurance listed below.

$200 Deductible for drugs in Tiers 3, 4, or 5; excluding Select Insulins*. (To find Select Insulins, look for “SI” in the 2022 formulary.)

Initial Coverage Limit (up to $4,430 total drug cost):

Preferred Pharmacy - Retail (up to a 90 day supply) 30 day 60 day 90 day
1 - Preferred Generic Drugs $0 copay $0 copay $0 copay
2 - Generic Drugs $8 copay $16 copay $24 copay
3 - Preferred Brand Drugs* $42 copay $84 copay $126 copay
Insulin Savings Program $35 copay $70 copay $105 copay
4 - Non-preferred Drugs* $95 copay $190 copay $285 copay
5 - Specialty Drugs* 31% of the cost Not available Not available
Standard Pharmacy - Retail (up to a 90 day supply) 30 day 60 day 90 day
1 - Preferred Generic Drugs $10 copay $20 copay $30 copay
2 - Generic Drugs $16 copay $32 copay $48 copay
3 - Preferred Brand Drugs* $47 copay $94 copay $141 copay
4 - Non-preferred Drugs* $100 copay $200 copay $300 copay
5 - Specialty Drugs* 29% of the cost Not available Not available
Mail Order Pharmacy - Retail (up to a 90 day supply) 30 day 60 day 90 day
1 - Preferred Generic Drugs $0 copay $0 copay $0 copay
2 - Generic Drugs $8 copay $16 copay $20 copay
3 - Preferred Brand Drugs* $45 copay $90 copay $125 copay
Insulin Savings Program $35 copay $70 copay $105 copay
4 - Non-preferred Drugs* $95 copay $190 copay $275 copay
5 - Specialty Drugs* 31% of the cost Not available Not available

Coverage Gap: The Coverage Gap begins after the total yearly drug cost reaches $4,430. If you reach the coverage gap, the plan pays 75% of the price for drugs and you pay the remaining 25% of the price. Not everyone will enter the Coverage Gap.

Catastrophic Coverage: After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050, you pay the greater of:

- 5% of the cost, or

- $3.95 copay for generic (including brand drugs treated as generic) and an $9.85 copay for all other drugs.

If you reach the Catastrophic Coverage Stage, you will stay in this payment stage until the end of the calendar year.

This is not a complete description of benefits.

For coverage details and additional co-payments/co-insurance, please see the Summary of Benefits. Conditions and limitations may apply. ‍

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or Your State Medicaid Office.

You must receive your care from a network provider.

In most cases, care you receive from an out-of-network provider (a provider who is not part of plan’s network) will not be covered. There are four exceptions:

  • The plan covers emergency care or urgently needed services that you get from an out-of-network provider.
  • If you need medical care that Medicare requires our plan to cover and the providers in our network cannot provide this care, you can get this care from an out-of-network provider with our prior approval. In this situation with our approval, you will pay the same as you would pay if you got the care from a network provider.
  • The plan covers kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area.
  • Our plan offers a point-of-service (POS) option for lab services, non-Medicare covered dental and vision services, hearing exams and hearing aids. For lab services, members may use the Medicare provider of their choice and services will be paid in-network. Molecular Diagnostics/Genetic testing requires prior authorization. For non-Medicare covered dental and vision services, members may use the provider of their choice and services will be reimbursed up to the plan annual maximum allowed. For hearing exams and/or hearing aids, you can use the provider of your choice, but you may have a higher out-of-pocket cost for hearing aids purchased from non-Amplifon providers. *The late enrollment penalty is an amount that is added to your Part D premium. You may owe a monthly late enrollment penalty if at any time after your initial enrollment period is over, there is a period of 63 or more days in a row when you don’t have Part D or other creditable prescription drug coverage. If you get "Extra Help" you do not pay a late enrollment penalty.

Ways to Enroll - Aultimate Plan

People may enroll in the plan only during specific times of the year. Contact PrimeTime Health Plan for more information. If you have questions or require language assistance, please call Customer Service at 330-363-7407 or 1-800-577-5084. For people who are hearing impaired, please call our TTY line at 711. Interpreter services are provided free of charge to you. A customer service representative is available to assist you Monday through Friday from 8:00 a.m. to 8:00 p.m. (October 1st – March 31st, we are available 7 days a week, 8:00 a.m. to 8:00 p.m.)

ONLINE

Beginning October 15, 2021, you can complete a secure online enrollment application by continuing with the green button below.

  • $0 Monthly Premium
  • $0 Annual Deductible
  • $4,500 Annual Out-of-Pocket Max

You will get an enrollment packet in the mail from PrimeTime Health Plan within seven to ten calendar days of enrolling online.


IN PERSON

You can visit us during our office hours Monday through Friday from 8:00 a.m. to 4:30 p.m. to drop off your completed enrollment application. Additionally, a PrimeTime Health Plan staff person is available to meet with you to discuss your plan options. You can complete an enrollment application during this appointment or take one with you to fill out and return. To schedule an appointment, please call 330-363-7407 or 1-800-577-5084. TTY users call 711. Our call center is available Monday through Friday from 8:00 a.m. to 8:00 p.m. (October 1st – March 31st, we are available 7 days a week, 8:00 a.m. to 8:00 p.m.).

PrimeTime Health Plan

Morrow House

2600 Sixth St SW

Canton, Ohio 44710

 

Download the application form (PDF)


BY MAIL

You can also choose to print and complete an enrollment application. When completed, mail the enrollment application to our office at:

PrimeTime Health Plan

Morrow House 2600 Sixth St SW

Canton, Ohio 44710

 

Download the application form (PDF)

Contact one of our friendly representatives.

We are here to help you.

Call one of our friendly representatives or click the button below to complete our contact us form. You can also check out our upcoming live webinars or on-demand archived webinars for more information.

Contact Us 

Trisha Witts PrimeTime Health Plan Team Member
Trisha Witts
330-363-2046
Debbie Banal PrimeTime Health Plan Team Member
Debbie Banal
330-363-2006
Karen Krantz PrimeTime Health Plan Team Member
Karen Krantz
330-363-2020