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Senior Blue 651 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Blue 651 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Senior Blue 651 (HMO) in 2026, please refer to our full plan details page.
Senior Blue 651 (HMO) is a HMO plan offered by Highmark Health available for enrollment in 2025 to people living in Western New York. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Senior Blue 651 (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 651 (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 651 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $97.00. 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 651 (HMO) Medicare plan has an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies or through preferred mail order. Tier 2 generic drugs are also highly affordable, costing a $3 copay for a 1-month supply at preferred pharmacies compared to a $15 copay at standard pharmacies. For higher-tier medications, the plan utilizes coinsurance rather than flat copays. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs both require a 20% coinsurance at all pharmacy and mail-order locations. Tier 5 specialty drugs have a 25% coinsurance for a 1-month supply at both preferred and standard pharmacies.
Additional Benefits
The Senior Blue 651 (HMO) plan offers comprehensive medical coverage featuring no copay for primary care physician visits and a $25 copay for specialist appointments. Inpatient hospital care requires a daily copay for the first several days before transitioning to no copay, while outpatient hospital services carry a $325 copay. Emergency room visits require a $130 copay, which is waived upon immediate admission, and urgent care services are available for a $50 copay. For routine health needs, members benefit from preventive dental care and annual physical exams with no copay, alongside a $200 annual allowance for eyewear. The plan also covers home health services with no copay and provides a $40 allowance every three months for over-the-counter items. Skilled nursing facility stays are covered with no copay for the first 20 days.
Inpatient Hospital See details
Senior Blue 651 (HMO) inpatient hospital care is covered with no coinsurance, though prior authorization is required. Acute stays require a $225 daily copay for days 1 through 7 and no copay for additional days, whereas psychiatric stays carry a $215 daily copay for days 1 through 6 and no copay for days 7 through 90. Some services are not covered, including acute room upgrades as well as psychiatric additional days and non-Medicare-covered stays.
Outpatient Services See details
Senior Blue 651 (HMO) covers outpatient services with no coinsurance, featuring a $325 copay for outpatient hospital and daily observation services, and a $225 copay for ambulatory surgical center services. Outpatient substance abuse services require a $40 copay per session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Senior Blue 651 (HMO) with a copayment of $55.00 and no coinsurance.
Ambulance and Transportation Services See details
Senior Blue 651 (HMO) covers ground and air ambulance services with a $200 copay and no coinsurance, though prior authorization is required. Routine transportation services to health-related locations are not covered.
Emergency Services See details
Senior Blue 651 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within one day. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $50, and $200 respectively.
Primary Care See details
Senior Blue 651 (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Most other services, including therapy, telehealth, and mental health, range from a $0 to $50 copay with no coinsurance, though chiropractic services are only partially covered because other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Senior Blue 651 (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, and select additional benefits like memory fitness and remote access technologies. However, several services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, home modifications, and counseling.
Hearing Services See details
Senior Blue 651 (HMO) covers hearing exams with a $25 to $45 copay and no coinsurance, alongside fitting and evaluation services. Prescription hearing aids are partially covered with a $499 to $799 copay and no coinsurance for up to two devices per year, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Senior Blue 651 (HMO) with no deductibles, offering one annual routine eye exam for a $25 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $200 yearly limit for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered under Senior Blue 651 (HMO), offering Medicare-covered dental for a $25 copay and no coinsurance, and preventive services like exams and cleanings with no copay and no coinsurance. Comprehensive dental services are covered with no copay and 0% to 50% coinsurance up to a $2,000 annual limit, though fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Senior Blue 651 (HMO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Senior Blue 651 (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Senior Blue 651 (HMO) covers medical equipment with no copays and required prior authorization, featuring a 0% to 20% coinsurance for durable medical equipment and a 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Senior Blue 651 (HMO) covers diagnostic and radiological services with prior authorization, offering diagnostic tests for a $40 copay with no coinsurance and lab services for a $5 copay with no coinsurance. Radiological services require a $40 copay for X-rays, a minimum $150 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Senior Blue 651 (HMO) covers Home Health Services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Senior Blue 651 (HMO) covers cardiac rehabilitation services with no coinsurance, though only some services are covered. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a $15 copayment.
Skilled Nursing Facility (SNF) See details
Senior Blue 651 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Senior Blue 651 (HMO) partially covers Other Services with no copay and no coinsurance, providing a meal benefit for chronic illness and a $40 allowance every three months for over-the-counter (OTC) items. Acupuncture is not covered under this benefit.
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