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Senior Blue 652 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Blue 652 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Senior Blue 652 (HMO) in 2025, please refer to our full plan details page.
Senior Blue 652 (HMO) is a HMO plan offered by Highmark Health available for enrollment in 2025 to people living in Northeastern New York. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Senior Blue 652 (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Senior Blue 652 (HMO).
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 Senior Blue 652 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $107.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6700.00 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 Senior Blue 652 (HMO) plan has an enhanced alternative drug benefit with a $0 deductible. In the initial coverage phase, you'll pay a copay for your prescriptions. For preferred generic drugs, the copay is $10 at a preferred pharmacy and $15 at a standard pharmacy. For standard generic drugs, the copay is $42 at a preferred pharmacy and $47 at a standard pharmacy. Preferred brand drugs have a $94 copay at a preferred pharmacy and a $100 copay at a standard pharmacy. Non-preferred drugs have a 33% coinsurance.
Additional Benefits
The Senior Blue 652 (HMO) plan provides coverage for a wide range of healthcare services, including inpatient and outpatient hospital care with varying copays, as well as emergency and ambulance services. The plan also includes coverage for primary care, preventive services, hearing, vision, and dental services, with copays and coinsurance applying to specific services like specialist visits, hearing exams, and dental procedures. Additionally, the plan offers benefits for home health, skilled nursing facilities, and other services, such as over-the-counter items and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but upgrades are not covered. For Inpatient Hospital-Acute, you pay a $225 copay for days 1-7, and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you pay a $260 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services are covered by the Senior Blue 652 (HMO) plan. Outpatient Hospital Services and Observation Services have a $300 copay, Ambulatory Surgical Center (ASC) Services have a $200 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40. Outpatient Blood Services are covered with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Senior Blue 652 (HMO) plan. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Senior Blue 652 (HMO) plan. Both ground and air ambulance services have a $200 copay, and there is no coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Senior Blue 652 (HMO) plan, with a $125 copay for emergency services, and a $55 copay for urgently needed services. Worldwide emergency services are also covered, including Worldwide Emergency Coverage with a $125 copay, Worldwide Urgent Coverage with a $55 copay, and Worldwide Emergency Transportation with a $200 copay.
Primary Care See details
The Senior Blue 652 (HMO) plan covers primary care services, chiropractic services with a $15 copay, occupational therapy, physician specialist services with a $26 copay, mental health specialty services with a $40 copay for individual and group sessions, podiatry services with a $26 copay, other health care professionals with a copay between $0 and $26, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a copay between $0 and $55, and opioid treatment program services with a $40 copay. Routine foot care is covered for up to 3 visits per year.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services, are covered by Senior Blue 652 (HMO). Additional services like Health Education, Fitness Benefit (Memory Fitness), Enhanced Disease Management, Telemonitoring Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered, while In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and several others are not covered.
Hearing Services See details
Hearing Services includes Hearing Exams with a $26 copay, and Prescription Hearing Aids with a copay between $499 and $799 depending on the type of hearing aid. Routine hearing exams have a $45 copay. Prescription hearing aids are not covered for inner ear, outer ear, or over the ear. OTC hearing aids are not covered.
Vision Services See details
The Senior Blue 652 (HMO) plan covers vision services, including eye exams with a copay of $0-$26, routine eye exams with a $25 copay, and eyewear with a combined maximum benefit of $200 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Senior Blue 652 (HMO) plan covers dental services, including oral exams with a $26 copay, dental x-rays, and prophylaxis (cleaning). The plan also covers restorative services, adjunctive general services, endodontics, prosthodontics (removable), prosthodontics (fixed), oral and maxillofacial surgery, with a 50% coinsurance, and periodontics with a 0-50% coinsurance. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Senior Blue 652 (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under Senior Blue 652 (HMO), including Durable Medical Equipment with a coinsurance between 0-20% and Prosthetics/Medical Supplies with a 20% coinsurance for some services, though Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic Procedures/Tests have a $50 copay, Lab Services have a $5 copay, Diagnostic Radiological Services have a $150 copay, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Senior Blue 652 (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Senior Blue 652 (HMO) plan. However, the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, SET for PAD Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Senior Blue 652 (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Senior Blue 652 (HMO) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $60 every three months, but does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, or the listed sub-services. The plan also covers a meal benefit for chronic illnesses.
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