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Senior Blue Basic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Blue Basic (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Senior Blue Basic (HMO) in 2025, please refer to our full plan details page.
Senior Blue Basic (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 Basic (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 Basic (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 Basic (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 $71.00. 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 $8300.00 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 Basic (HMO)
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Drug Coverage
The Senior Blue Basic (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $12 copay at preferred pharmacies, while standard generic drugs have 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), your Part D costs are $0.
Additional Benefits
The Senior Blue Basic (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. Emergency and primary care services are covered, and the plan includes coverage for preventive services. Additional benefits include dental, vision, and hearing services with specific copays and coinsurance. The plan also covers home health services, medical equipment, and diagnostic services. However, certain services like eyewear, hearing aids, and some dental procedures 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 will pay a $375 copay for days 1-6, and no copay for days 7-90, while Inpatient Hospital Psychiatric has a $335 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services, each with a $475 copay, Ambulatory Surgical Center (ASC) Services with a $425 copay, and Outpatient Substance Abuse Services with $40 copay for both individual and group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Senior Blue Basic (HMO) plan. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $275 copay for both ground and air ambulance services and 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 the Senior Blue Basic (HMO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
Primary Care Physician Services are covered with a copay between $0 and $10. Chiropractic Services, including routine care, are covered with a $15 copay. Occupational Therapy Services have a $35 copay. Physician Specialist Services have a $50 copay. Mental Health Specialty Services, including individual and group sessions, have a $40 copay. Podiatry Services and Routine Foot Care have a $50 copay. Other Health Care Professional services have a copay between $0 and $50. Psychiatric Services, including individual and group sessions, have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a $40 copay. Additional Telehealth Benefits have a copay between $0 and $50. Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, health education, fitness benefits, enhanced disease management, telemonitoring services, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. The plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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, or counseling services.
Hearing Services See details
Hearing Services are covered by the Senior Blue Basic (HMO) plan, but routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types, inner ear, outer ear, and over the ear) are not covered. Hearing exams have a $50 copay.
Vision Services See details
Vision Services include eye exams with a copay of $0 - $50 and Routine Eye Exams with a $25 copay. Eyewear benefits are partially covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $50 copay, Oral Exams with a $20 copay, Dental X-Rays with a $20 copay, Prophylaxis (Cleaning) with a $20 copay, Fluoride Treatment with a $20 copay, Restorative Services with 0-50% coinsurance, Adjunctive General Services with 0-50% coinsurance, Endodontics with 50% coinsurance, Periodontics with a $20 copay, Prosthodontics, removable with 50% coinsurance, Prosthodontics, fixed with 50% coinsurance, and Oral and Maxillofacial Surgery with 50% coinsurance; however, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. The plan has a maximum benefit of $1000 per year.
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 Basic (HMO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 0-20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered, as are Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, lab services, and radiological services. Diagnostic Procedures/Tests have a $60 copay, Lab Services have a $10 copay, and Outpatient X-Ray Services have a $50 copay; Diagnostic Radiological Services have a $225 copay, and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Senior Blue Basic (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of 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 are not covered. The plan has a copay for covered services; however, the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; there is no coinsurance.
Other Services See details
The Senior Blue Basic (HMO) plan does not cover acupuncture, over-the-counter items, 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, or Self-Directed Personal Assistance Services. The plan does cover a meal benefit for a chronic illness.
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