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Senior Blue Select (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Blue Select (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Senior Blue Select (HMO) in 2025, please refer to our full plan details page.
Senior Blue Select (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 Select (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 Select (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 Select (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. 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:
Sign up for Senior Blue Select (HMO)
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Drug Coverage
The Senior Blue Select (HMO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, you will pay a $10 copay at a preferred pharmacy and a $15 copay at a standard pharmacy. For other tiers, you will pay coinsurance between 25% and 40%. Once your total drug costs reach $2,000, you will enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Senior Blue Select (HMO) plan offers a variety of benefits, including inpatient and outpatient hospital care, with varying copays depending on the service. Emergency, primary care, and preventive services are also covered, along with hearing, vision, and dental services. Prescription hearing aids are covered with a copay, and vision includes eye exams and eyewear with a yearly maximum. The plan also covers ambulance, home health, and skilled nursing facility services with specific copays or coinsurance, as well as diagnostic and radiological services. Additional benefits include coverage for home infusion, dialysis, and durable medical equipment. However, some services like cardiac rehabilitation, certain hearing aids, and specific dental and vision procedures may not be covered.
Inpatient Hospital See details
The Senior Blue Select (HMO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you'll pay a $335 copay for days 1-5, and no copay for days 6-90; the service-specific out-of-pocket maximum is $1675. Inpatient Hospital Psychiatric has a $260 copay for days 1-6, and no copay for days 7-90, with a service-specific out-of-pocket maximum of $1560. Additional days and upgrades for Inpatient Hospital-Acute are covered, while upgrades are not covered. Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, are covered. Outpatient hospital services and observation services have a $400 copay, ambulatory surgical center (ASC) services have a $300 copay, and individual and group outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Senior Blue Select (HMO) plan. Ground and Air Ambulance Services have a $300 copay, with 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 by Senior Blue Select (HMO). Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $55 copay, and Worldwide Emergency Transportation has a $300 copay; there is no coinsurance for these services.
Primary Care See details
The Senior Blue Select (HMO) plan covers Primary Care Physician Services, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $30 copay, Mental Health Specialty Services with a $40 copay, Podiatry Services with a $30 copay, Other Health Care Professional services with a copay between $0-$30, Psychiatric Services with a $40 copay, Physical Therapy and Speech-Language Pathology Services with a $25 copay, Additional Telehealth Benefits with a copay between $0-$55, and Opioid Treatment Program Services with a $40 copay. Routine Chiropractic Care has a $15 copay for 12 visits per year.
Preventive Services See details
The Senior Blue Select (HMO) plan covers preventive services, including annual physical exams, health education, kidney disease education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, Fitness Benefit (Memory Fitness), Enhanced Disease Management, and Telemonitoring Services. However, 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 (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services are covered by the Senior Blue Select (HMO) plan, including hearing exams with a $30 copay. Prescription Hearing Aids (all types) are covered with a copay between $499 and $799, however, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay of $0-$30, and eyewear, including contact lenses, eyeglass lenses, and frames. Eyewear has a combined maximum plan benefit coverage of $200 per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, along with other dental services such as oral exams, dental x-rays, prophylaxis (cleaning), and restorative services with 50% coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered, while orthodontics have a $2,000 maximum benefit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, you'll pay a $35 copay and between 0% and 20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you'll pay between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Senior Blue Select (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a $50 copay, and diagnostic radiological services with a $175 copay. The plan also covers therapeutic radiological services with a 20% coinsurance, and outpatient X-ray services with a $45 copay. Lab services are not covered.
Home Health Services See details
Home Health Services are covered by the Senior Blue Select (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Senior Blue Select (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Senior Blue Select (HMO) plan, requiring prior authorization. There is no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with a maximum benefit of $70 every three months, and a Meal Benefit for a chronic illness. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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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