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Forever Blue 751 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Forever Blue 751 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Forever Blue 751 (PPO) in 2025, please refer to our full plan details page.
Forever Blue 751 (PPO) is a PPO 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 2025.
It's important to know that Forever Blue 751 (PPO) 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 Forever Blue 751 (PPO).
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 Forever Blue 751 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $197.00. 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 combined Maximum Out-Of-Pocket cost of $10000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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
The Forever Blue 751 (PPO) plan has an "Enhanced Alternative" drug benefit. This plan has no deductible. In the initial coverage phase, you'll pay a copay for your prescriptions. For example, preferred generic drugs have an $8 copay at a preferred pharmacy, while standard generic drugs have a $42 copay. Non-preferred drugs have a 33% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase, and you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Forever Blue 751 (PPO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. Primary care visits have no copay, while specialist visits, mental health, and other services have copays ranging from $5 to $55. The plan also includes coverage for preventive services, hearing and vision services, and dental services, with specific copays and coinsurance amounts depending on the service. This plan provides additional coverage for ambulance, emergency, and skilled nursing facility services, with associated copays or coinsurance. Home health services are covered with no copay, but require authorization. Additionally, the plan offers benefits for medical equipment, diagnostic and radiological services, and other services, such as OTC items, with specific cost-sharing arrangements.
Inpatient Hospital See details
Inpatient Hospital coverage for the Forever Blue 751 (PPO) plan includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with copays ranging from $0 to $270 per day depending on the service and the length of stay. Additional days for Inpatient Hospital-Acute are covered, while upgrades, additional days, and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Forever Blue 751 (PPO) plan, including all outpatient hospital services, observation services, and outpatient substance abuse services. Outpatient Hospital Services and Observation Services have a $300 copay. Ambulatory Surgical Center (ASC) Services have a $200 copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay between $40 and $40. Outpatient Blood Services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Forever Blue 751 (PPO) plan with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Forever Blue 751 (PPO) plan. Ground and Air Ambulance Services have a $225 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 under the Forever Blue 751 (PPO) plan. 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 $225 copay.
Primary Care See details
Primary Care, including Primary Care Physician Services, is covered with a copay of $0-$5. Chiropractic Services, including routine care, is covered with a $15 copay for each visit, up to 12 visits per year. Occupational Therapy Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services are covered with copays of $20, $25, and $20, respectively. Mental Health Specialty Services, including individual and group sessions, have a $40 copay. Podiatry Services and Other Health Care Professional services have copays of $25 and $0-$25, respectively. Psychiatric Services, including individual and group sessions, have a $40 copay. Additional Telehealth Benefits are covered with a copay of $0-$55. Opioid Treatment Program Services are covered with a $40 copay.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services, annual physical exams, and additional preventive services. Health Education, Fitness Benefit (Memory Fitness), Enhanced Disease Management, Telemonitoring 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 (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 includes Hearing Exams and Prescription Hearing Aids. Hearing Exams have a $25 copay, and Routine Hearing Exams are limited to 1 per year with a copay between $45 and $45, while Fitting/Evaluation for Hearing Aid is unlimited. Prescription Hearing Aids (all types) are limited to 2 per year with a copay between $499 and $799, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
The Forever Blue 751 (PPO) plan covers vision services including eye exams, with a copay of $0-$25 for routine eye exams, and eyewear with a combined maximum benefit of $200 per year, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Forever Blue 751 (PPO) plan covers Medicare dental services with a $25 copay, and other dental services including oral exams, dental x-rays, and prophylaxis (cleaning). Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative services, adjunctive general services, endodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have a 50% coinsurance, while periodontics has a 0-50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Forever Blue 751 (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
The Forever Blue 751 (PPO) plan covers medical equipment with a coinsurance between 0% and 20% for Durable Medical Equipment (DME), and a 20% coinsurance for prosthetic devices and medical supplies, but does not cover Durable Medical Equipment for use outside the home, diabetic supplies, or diabetic therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a $40 copay and Lab Services with a $5 copay. Radiological Services include a copay of at most $150 for Diagnostic services, a coinsurance of at least 20% for Therapeutic services, and a $40 copay for Outpatient X-Ray services.
Home Health Services See details
Home Health Services are covered by Forever Blue 751 (PPO) with no copay or coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Forever Blue 751 (PPO) plan. Although the plan covers Cardiac Rehabilitation Services generally, specific services such as 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Forever Blue 751 (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Forever Blue 751 (PPO) plan's "Other Services" benefit covers Over-the-Counter (OTC) Items with a maximum benefit of $60 every three months, and a meal benefit for chronic illnesses. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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