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BlueSaver (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueSaver (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueSaver (HMO) in 2025, please refer to our full plan details page.
BlueSaver (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 BlueSaver (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 BlueSaver (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 BlueSaver (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 $4.00. 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.
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 $6900.00 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 BlueSaver (HMO)
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Drug Coverage
The BlueSaver (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a $2 copay for preferred generic drugs at a preferred pharmacy, and 25% coinsurance for standard generic drugs. For preferred brand drugs, you'll pay 50% coinsurance, while non-preferred drugs have a 33% coinsurance. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The BlueSaver (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services range from $40 to $375. Emergency services have copays between $45 and $270. This plan covers primary care and specialist visits with copays, and includes hearing, vision, and dental benefits. It also offers home health services with no copay, and covers skilled nursing facilities with a copay after 20 days. The plan provides additional benefits like OTC items, but excludes some services like cardiac rehabilitation.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. Inpatient Hospital-Acute has a copay of $350 for days 1-6 and no copay for days 7-90, while Inpatient Hospital Psychiatric has a copay of $395 for days 1-4 and no copay for days 5-90; additional days for Inpatient Hospital-Acute are covered with no copay.
Outpatient Services See details
Outpatient Services are covered by the BlueSaver (HMO) plan. Outpatient Hospital Services and Observation Services have a $375 copay, Ambulatory Surgical Center (ASC) Services have a $275 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay between $40 and $40.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueSaver (HMO) plan. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueSaver (HMO) plan, including both ground and air ambulance services with a $270 copay, and no coinsurance. Transportation Services to any health-related location are not covered by this plan.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the BlueSaver (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $45 copay, and Worldwide Emergency Transportation has a $270 copay. There is no coinsurance for any of these services.
Primary Care See details
The BlueSaver (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $30 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 $0 - $30 copay, psychiatric services with a $40 copay, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a $0 - $55 copay, and opioid treatment program services with a $40 copay. Routine Chiropractic Care is covered up to 6 visits per year.
Preventive Services See details
Preventive Services, including Medicare-covered services and annual physical exams, are covered. Additional preventive services such as 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 with the BlueSaver (HMO) plan includes hearing exams with a $30 copay, and routine hearing exams with a $45 copay, once per year. Prescription hearing aids are partially covered, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The BlueSaver (HMO) plan covers vision services including routine eye exams with a $25 copay, and eyewear 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
The BlueSaver (HMO) plan covers Medicare Dental Services with a $30 copay, and other dental services with a $2,000 maximum benefit per year. The plan covers oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments, each limited to one visit at a specific periodicity, and restorative services, adjunctive general services, and periodontics with a coinsurance between 0% and 50%. Endodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with a 50% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with a $35 copay for Medicare Part B Insulin Drugs and a coinsurance between 0% and 20% for all covered services. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the BlueSaver (HMO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered by the BlueSaver (HMO) plan. Durable Medical Equipment (DME) has a coinsurance of 0% to 20% and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while there is 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 include coverage for diagnostic procedures and tests with a $50 copay, and outpatient X-ray services with a $45 copay. Diagnostic Radiological Services have a copay of at least $175, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the BlueSaver (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 BlueSaver (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueSaver (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 BlueSaver (HMO) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $140 every three months, and a meal benefit for chronic illnesses, but does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, or several other services including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and Case Management (Long Term Care).
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