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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 2025, 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 4.5 out of 5 stars in 2025.
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 $101.00. 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 651 (HMO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, the copay is $10 at a preferred pharmacy and $15 at a standard pharmacy. The copay for standard generic drugs 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. For non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Senior Blue 651 (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the service. This plan also covers primary care, specialist visits, mental health, and other services like hearing and vision, with copays ranging from $0 to $40. Additionally, the plan provides coverage for dental, home health services, and medical equipment, and includes an OTC benefit, offering a maximum of $60 every three months, and a meal benefit for chronic illness. Emergency, ambulance, and skilled nursing facility services are covered, with copays and coinsurance depending on the service. The plan also covers home infusion bundled services, dialysis, and diagnostic and radiological services. However, certain services like cardiac rehabilitation, additional hours of care, and specific dental and hearing services are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For Inpatient Hospital-Acute, you pay a $225 copay for days 1-7 and no copay for days 8-90, while for Inpatient Hospital Psychiatric, you pay a $215 copay for days 1-6 and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services and observation services have a $325 copay, while ambulatory surgical center services have a $225 copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Senior Blue 651 (HMO) plan. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and Air Ambulance Services have a $200 copay, while other transportation services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Senior Blue 651 (HMO) plan. Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a $55 copay and no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $200 copay; all have no coinsurance.
Primary Care See details
The Senior Blue 651 (HMO) plan covers primary care, chiropractic services, occupational therapy, specialist services, mental health, podiatry, other health care professional, psychiatric services, physical therapy, telehealth, and opioid treatment program services. Chiropractic services have a $15 copay, specialist services have a $25 copay, physical therapy and speech-language pathology services have a $15 copay, and individual/group mental health and psychiatric sessions have a $40 copay. Other services have varying copays.
Preventive Services See details
The Senior Blue 651 (HMO) plan covers a variety of preventive services, including annual physical exams, health education, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $25 copay. Routine hearing exams have a copay of $45, and you are limited to one exam per year. Prescription hearing aids (all types) are covered with a copay between $499 and $799, with a limit of two hearing aids per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$25, and eyewear with a combined maximum benefit of $200 per year. Eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and contact lenses are also covered.
Dental Services See details
Dental Services includes coverage for oral exams with a $25 copay, dental x-rays, and prophylaxis (cleaning) with no copay; however, fluoride treatment is not covered. Orthodontic services are covered up to a maximum of $2000 per year, and restorative services, adjunctive general services, endodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have a 50% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. Other Medicare Part B drugs have coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Senior Blue 651 (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits for Senior Blue 651 (HMO) include Durable Medical Equipment (DME) with 0-20% coinsurance and authorization required, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a $40 copay, and lab services with a $5 copay. Radiological services include a copay of up to $150 for diagnostic services, a coinsurance of at least 20% for therapeutic services, and a $40 copay for outpatient X-rays.
Home Health Services See details
Home Health Services are covered by the Senior Blue 651 (HMO) plan, with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Senior Blue 651 (HMO) plan. Though this benefit is generally covered, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are specifically not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Senior Blue 651 (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 651 (HMO) plan covers Over-the-Counter (OTC) Items with a maximum benefit coverage amount of $60 every three months, but does not cover acupuncture. The plan also offers a meal benefit for a chronic illness. Other services are not covered.
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