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Senior Blue 601 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Blue 601 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Senior Blue 601 (HMO) in 2025, please refer to our full plan details page.
Senior Blue 601 (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 601 (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Senior Blue 601 (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 601 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Senior Blue 601 (HMO).
Additional Benefits
The Senior Blue 601 (HMO) plan offers a range of benefits, including inpatient hospital stays with copays ranging from $0-$290, and outpatient services with copays from $40-$325. Primary care visits have no copay or a $5 copay, and specialist visits have copays from $15-$45. The plan also covers hearing and vision services, with copays for exams and coverage for hearing aids and eyewear. Additional benefits include dental services with 50% coinsurance for some services, along with ambulance, emergency, and home health services. The plan also covers durable medical equipment, skilled nursing facilities, and home infusion services. There is also an OTC benefit with a maximum of $25 every three months, and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital services are covered by the Senior Blue 601 (HMO) plan. For Inpatient Hospital-Acute, you pay a $290 copay for days 1-7, and no copay for days 8-90; 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 include outpatient hospital services with a $325 copay, observation services with a $325 copay per day, ambulatory surgical center (ASC) services with a $225 copay, and outpatient substance abuse services with a $40-$40 copay for individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Senior Blue 601 (HMO) plan, with a copay of $55.
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, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $200 copay.
Primary Care See details
The Senior Blue 601 (HMO) plan covers primary care physician services with a copay of $0-$5, chiropractic services with a $15 copay, and occupational therapy services with a $15 copay. The plan also covers physician specialist services with a $45 copay, mental health specialty services with a $40 copay, and podiatry services with a $45 copay. Additionally, other health care professional visits have a $0-$45 copay, psychiatric services have a $40 copay, and physical therapy and speech-language pathology services have a $15 copay. Additional telehealth benefits have a $0-$55 copay, and opioid treatment program services have a $40 copay.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, health education, fitness benefits (memory fitness), enhanced disease management, telemonitoring services, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, are covered. In-home safety assessment, personal emergency response system (PERS), medical nutrition therapy (MNT), 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 benefit, 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 $45 copay, and prescription hearing aids. Prescription hearing aids have a copay between $599 and $899, depending on the type. OTC hearing aids, and prescription hearing aids - Inner Ear, Outer Ear, and Over the Ear are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $45, and routine eye exams once per year. Eyewear is covered with a combined maximum benefit of $100 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services include coverage for oral exams with a $45 copay, and dental x-rays and prophylaxis (cleaning), both of which are limited to one visit and are not unlimited. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with 50% coinsurance, while fluoride treatment, maxillofacial prosthetics, implant services, 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 a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Senior Blue 601 (HMO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
The Senior Blue 601 (HMO) plan covers Durable Medical Equipment with 0-20% coinsurance and no copay, but does not cover Durable Medical Equipment for use outside the home. Prosthetic Devices and Medical Supplies are covered with a 20% coinsurance and no copay. 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, but Lab Services are not covered. Diagnostic Procedures/Tests have a $45 copay. Diagnostic Radiological Services have a $150 copay, and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Senior Blue 601 (HMO) plan with no copay and no coinsurance; however, Additional Hours of Care and Personal Care Services are not covered. This benefit does require authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Senior Blue 601 (HMO) plan. The plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Senior Blue 601 (HMO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items and a Meal Benefit, but acupuncture is not covered. The OTC benefit offers a maximum of $25 every three months, and the meal benefit is for chronic illnesses. Additionally, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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