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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 2026, 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 out of 5 stars in 2026.
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 $104.00. 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 a $615.00 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 $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 features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies or through preferred mail order, while standard pharmacies charge a $7 copay for a one-month supply. Tier 2 generic medications cost as little as a $1 copay for a one-month supply at preferred pharmacies, compared to a $15 copay at standard locations. For higher-tier medications, the plan transitions from flat copayments to coinsurance. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance across all pharmacy options. Utilizing preferred pharmacies and preferred mail-order services offers the most cost-effective way to manage your prescription drug expenses under this plan.
Additional Benefits
The Senior Blue 652 (HMO) plan offers robust medical coverage featuring no copay for primary care visits and a $26 copay for specialist consultations. For hospital care, inpatient acute stays require a $225 daily copay for the first seven days with no copay thereafter, while outpatient hospital services carry a $300 copay and no coinsurance. Emergency care is accessible with a $130 copay, which is waived upon admission, and urgent care visits require a $50 copay. Eligible members also benefit from preventive services and home health care with no copay and no coinsurance. Supplemental coverage includes preventive dental care with no copay, routine vision exams for a $25 copay alongside a $200 annual eyewear allowance, and prescription hearing aid benefits. Additionally, the plan provides a $60 quarterly allowance for over-the-counter health items with no copay or coinsurance.
Inpatient Hospital See details
Senior Blue 652 (HMO) covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Acute stays require a $225 daily copay for days 1 to 7 and no copay for remaining unlimited days, though upgrades are not covered. Psychiatric stays require a $260 daily copay for days 1 to 6 and no copay for days 7 to 90, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Senior Blue 652 (HMO) covers outpatient services with no coinsurance, featuring a $300 copay for outpatient hospital and observation services and a $200 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Senior Blue 652 (HMO) plan, featuring a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Senior Blue 652 (HMO) covers ground and air ambulance services with a $200 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Senior Blue 652 (HMO) with a $130 copay—which is waived if you are admitted to the hospital within one day—and no coinsurance. Urgently needed services have a $50 copay, and worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $50 to $200.
Primary Care See details
Senior Blue 652 (HMO) provides primary care physician services with no copay and no coinsurance, and specialist visits for a $26 copay and no coinsurance. Chiropractic services are partially covered, excluding other chiropractic services, with a $15 copay and no coinsurance, while therapies cost a $15 copay and mental health services cost a $40 copay, both with no coinsurance.
Preventive Services See details
Preventive services are partially covered by Senior Blue 652 (HMO) with no copay and no coinsurance for covered benefits such as annual physical exams, diabetes self-management, and memory fitness. However, several services are not covered, including health education, in-home safety assessments, personal emergency response systems, and weight management programs.
Hearing Services See details
Senior Blue 652 (HMO) hearing services are partially covered with no deductible and no coinsurance, featuring a $26 copay for exams ($45 for annual routine exams) and copays between $499 and $799 for prescription hearing aids. Up to two prescription hearing aids are covered per year, though OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Senior Blue 652 (HMO), which offers routine eye exams with a $25 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $200 annual maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
Senior Blue 652 (HMO) provides partially covered dental services, offering Medicare-covered dental care for a $26 copay and no coinsurance, alongside preventive cleanings and exams with no copay and no coinsurance. Restorative and surgical services require no copay and 50% coinsurance under a $2,000 annual limit, but fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Senior Blue 652 (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Medicare Part B chemotherapy, insulin, and other covered drugs range from no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Senior Blue 652 (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is partially covered by Senior Blue 652 (HMO) with no copay for all covered categories, featuring 0% to 20% coinsurance for durable medical equipment and 20% coinsurance for prosthetics and medical supplies. While diabetic equipment has no copay and no coinsurance, diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Senior Blue 652 (HMO) covers diagnostic services with no coinsurance, requiring a $5 copay for lab services and a $50 copay for diagnostic procedures and tests. Covered radiological services require prior authorization and include a $50 copay for outpatient X-rays, a minimum $150 copay for diagnostic radiological services, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Senior Blue 652 (HMO) covers Home Health Services with no copay and no coinsurance. This benefit ensures eligible members can receive necessary medical care in their homes at no cost.
Cardiac Rehabilitation Services See details
Senior Blue 652 (HMO) covers some Cardiac Rehabilitation Services with no coinsurance and a $10 copay, but cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Senior Blue 652 (HMO) with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, no prior three-day hospital stay is needed, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Senior Blue 652 (HMO) partially covers other services, offering chronic illness meal benefits and up to $60 every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, nicotine replacement therapy, and naloxone are not covered under this plan.
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