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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 2026, 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 out of 5 stars in 2026.
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.
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.
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 comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay to a $5 copay for primary care visits and a $45 copay for specialists. Inpatient hospital stays require a $290 daily copay for the first seven days and no copay thereafter, with no coinsurance. Emergency room visits carry a $130 copay, which is waived upon hospital admission, and outpatient hospital services require a $325 copay with no coinsurance. For routine wellness, members benefit from preventive dental cleanings and annual physical exams with no copay or coinsurance, while comprehensive dental is covered at 50% coinsurance up to a $2,000 annual limit. Vision and hearing benefits include routine exams with copays up to $45 and no coinsurance, plus coverage for eyewear and prescription hearing aids. Additionally, home health services are provided with no copay, and durable medical equipment incurs a 0% to 20% coinsurance with no copay.
Inpatient Hospital See details
Senior Blue 601 (HMO) covers inpatient acute hospital stays with no coinsurance and a $290 daily copay for days 1 to 7 (no copay for days 8 and beyond), though room upgrades are not covered. Inpatient psychiatric hospital care is also covered with no coinsurance and a $260 daily copay for days 1 to 6 (no copay for days 7 to 90), but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Senior Blue 601 (HMO) covers outpatient services with no coinsurance, featuring a $325 copay for outpatient hospital and observation services and a $225 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
Senior Blue 601 (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. This coverage ensures affordable access to these intensive outpatient services with clear, predictable costs.
Ambulance and Transportation Services See details
Senior Blue 601 (HMO) covers Medicare-covered ground and air ambulance services with a $300 copay per service and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered by this plan.
Emergency Services See details
Senior Blue 601 (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 $300 respectively.
Primary Care See details
Senior Blue 601 (HMO) provides primary care physician services with no copay to a $5 copay, alongside specialist visits for a $45 copay, with no coinsurance for either service. Other benefits like therapy, mental health, and telehealth are covered with copays ranging from no copay to $50 and no coinsurance, though chiropractic care is only partially covered as other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Senior Blue 601 (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, and other screenings. Additional preventive services are partially covered, offering memory fitness, enhanced disease management, and remote access technologies, while sub-services like health education, personal emergency response systems, and nutritional benefits are not covered.
Hearing Services See details
Senior Blue 601 (HMO) hearing services are partially covered, offering routine exams and fitting evaluations for a $45 copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay between $599 and $899, 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 offered by Senior Blue 601 (HMO), featuring partially covered eye exams with a $0 to $45 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a combined maximum benefit of $100 per year for contacts, lenses, frames, and upgrades.
Dental Services See details
Senior Blue 601 (HMO) covers Medicare-covered dental services for a $45 copay and no coinsurance, and preventive care like cleanings and exams with no copay and no coinsurance. Comprehensive treatments are covered with no copay and 50% coinsurance up to a $2,000 annual limit, though fluoride, implants, orthodontics, maxillofacial prosthetics, crowns, inlays, and onlays are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under Senior Blue 601 (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Senior Blue 601 (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Senior Blue 601 (HMO) covers durable medical equipment with no copay and 0% to 20% coinsurance, as well as prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Senior Blue 601 (HMO) diagnostic and radiological services are partially covered, as lab services are not covered. Covered diagnostic procedures and outpatient X-rays require a $45 copay with no coinsurance, while diagnostic radiological services carry a minimum $150 copay and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Senior Blue 601 (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Senior Blue 601 (HMO) with no coinsurance, meaning some services are covered; however, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Senior Blue 601 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires prior authorization, with no prior three-day hospital stay required. 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 Medicare-covered limit are not covered.
Other Services See details
Senior Blue 601 (HMO) partially covers Other Services with no copay and no coinsurance, which includes a meal benefit for chronic illness and up to $25 every three months for over-the-counter items. Acupuncture is not covered under this benefit.
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