Plan H3351-012-0: Univera SeniorChoice Value Plus (HMO-POS) – 2025 Coverage Details for Cattaraugus County, NY
This page provides coverage, cost, and availability details for Excellus Health Plan, Inc’s H3351-012-0 Medicare Advantage plan for 2025.
See more Medicare Advantage Plans in Cattaraugus County, New York.
*CMS rated this Excellus Health Plan, Inc plan (H3351-012-0) 4 (Good) out of 5 stars.
Univera SeniorChoice Value Plus Basic Plan Details
- Plan ID
- H3351-012-0
- Plan Type
- HMO-POS
- Plan Year
- 2025
- Premium
- $57.30/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 6,700.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Enhanced, $0.00 deductible
- Supplemental Benefits
- Vision, Hearing
- Availability
- Cattaraugus County, NY
- Insured By
- Excellus Health Plan, Inc
| Summary of Benefits |
|---|
Health Plan Out-of-Pocket Costs
This Excellus Health Plan, Inc Part C plan has cost-sharing. These are costs you pay out-of-pocket when you use approved health services. The following table summarizes the most common in-network out-of-pocket costs in plan H3351-012-0.
NOTE: Certain preventive services are covered 100% by the plan as a Part B benefit.
Doctor's Office Visits
- Primary
- Not Covered
- Specialist
- $35 Copay
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $110 Copay
- Urgent care
- $50 Copay
- Ground ambulance
- $200 Copay
- Inpatient hospital care
- $310.00 per day for days 1 through 5
$0.00 per day for days 6 and beyond - Skilled Nursing Facility
- $0.00 per day for days 1 through 20
$214.00 per day for days 21 and beyond
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- $35 Copay
- Routine Foot Care
- Not Covered
Chiropractic Care
- Medicare-covered chiropractic
- $15 Copay
- Routine chiropractic
- Not Covered
Mental Health Services
- Outpatient individual therapy
- 20% Coinsurance
- Outpatient group therapy
- 20% Coinsurance
- Inpatient psychiatric hospital care
- $310.00 per day for days 1 through 5
$0.00 per day for days 6 and beyond
Rehabilitation Services
- Physical therapy and speech and language therapy
- $35 Copay
Prior Authorization Required - Occupational therapy
- $35 Copay
Prior Authorization Required
Medical Equipment and Supplies
- Diabetes supplies
- $5 Copay
Prior Authorization Required - Durable medical equipment
- 20% Coinsurance
Prior Authorization Required - Prosthetics
- 20% Coinsurance
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- $175 Copay
Prior Authorization Required - Lab services
- Not Covered
- Outpatient x-rays
- $50 Copay
Prior Authorization Required - Diagnostic tests and procedures
- Not Covered
Medicare Part B Drugs
- Chemotherapy
- 20% Coinsurance
- Other Part B drugs (Medicare-covered)
- 20% Coinsurance
Dental Services
- Medicare Covered Preventive Dental
- $35 Copay
- Oral exam
- $0
- Dental x-rays
- $0
- Cleaning
- $0
- Periodontics
- Not Covered
- Endodontics
- Not Covered
- Restorative Services
- Not Covered
Hearing Aids and Services
- Fitting/evaluation
- Covered
Limits may apply - Hearing aids
- Not Covered
- Hearing exam
- Covered
Limits may apply
Vision Services
- Medicare-covered eye exam
- Routine eye exam
- Covered
Limits may apply - Eyewear benefits
- None
Prescription Drug Costs & Benefits
Univera SeniorChoice Value Plus includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.
As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.
Prescription Drug Premium with Extra Help
Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| Low Income Premium Subsidy CMS Pays: | $57.30 |
| Low Income Subsidy Premium: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Deductible
The Medicare Part D annual deductible with this plan is $0.00. You must pay this amount at the pharmacy before Excellus Health Plan, Inc begins paying its share.
Prescription Drug Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Univera SeniorChoice Value Plus has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 | $5.00 |
| Generic | $10.00 | $15.00 |
| Preferred Brand | $42.00 | $47.00 |
| Non-Preferred Drug | 50.00% | 50.00% |
| Specialty Tier | 33.00% | 33.00% |
| *The Part D deductible does not apply. | ||
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates health plans (Part C) and drug plans (Part D) in several major categories using a 5-star rating system. These ratings are designed to help you understand the quality of care and service you can expect if you join Univera SeniorChoice Value Plus .
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Additional Plan Options
The Medicare Part C program offers a myriad of HMO, PPO, and PFFS plan options, including these plans:
- Medicare Blue Choice Optimum (HMO-POS)
- Medicare Blue Choice Extra (HMO)
- Univera SeniorChoice Advanced (HMO-POS)
- Univera SeniorChoice Basic (HMO)
- Medicare Blue Choice Value Plus (HMO-POS)
- Medicare Blue Choice Advanced (HMO-POS)
- Univera Medicare Freedom (HMO-POS)
If you are enrolled in a Part C plan with prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D plan, regardless of your chosen insurance company.
You cannot be enrolled in a Part C health plan and simultaneously hold Medicare Supplement Insurance (Medigap). Medicare Supplement plans are only compatible with Medicare Parts A and B.
Contact Us About Excellus Health Plan, Inc
| Website: | Excellus Health Plan, Inc Plan Page (opens in new tab) |
|---|---|
| Providers: | Excellus Health Plan, Inc Providers Page (opens in new tab) |
| Formulary: | Excellus Health Plan, Inc Formulary Page (opens in new tab) |
| Pharmacy: | Excellus Health Plan, Inc Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (800)659-1986 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (800)659-1986 |
| New Member Part D TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Part C program on www.medicare.gov or call 1-800-MEDICARE.
Citations & References
- Excellus Health Plan, Inc, http://www.UniveraMedicare.com, Last Accessed March 1, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed January 21, 2024
- Medicare.gov, "Your Medicare coverage choices", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You in Different Formats", Last Accessed February 19, 2024
- Medicare.gov, "Is Your Test, Item, or Service Covered?", Last Accessed March 19, 2025
- CMS.gov, Landscape Source Files, Last Accessed March 15, 2025
- CMS.gov, Medicare Part C & D Performance, Last Accessed March 15, 2025
- CMS.gov, Plan Benefits Package,Last Accessed March 15, 2025
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
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