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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 2026, 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 4.5 out of 5 stars in 2026.
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 $210.00. 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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) Medicare prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for 1-month or 3-month supplies filled at preferred pharmacies or through preferred mail order. Tier 2 generic drugs are also highly affordable, with copays starting at $3 for a 1-month supply at a preferred pharmacy. For higher-tier medications, coverage transitions from flat copays to coinsurance. Tier 3 preferred brands require a 20% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty medications require a 25% coinsurance for your prescriptions.
Additional Benefits
The Forever Blue 751 (PPO) plan offers comprehensive medical coverage with predictable costs, featuring no copays and no coinsurance for preventive care and home health services. Routine doctor visits are highly affordable, with copays ranging from no copay to $5 for primary care and $25 for specialists. For emergency situations, members pay a $130 copay for emergency room visits, which is waived if admitted, and a $225 copay for ambulance services, both with no coinsurance. Inpatient hospital stays require daily copays for the initial days before transitioning to no copay, while outpatient hospital services carry a $300 copay with no coinsurance. Supplemental benefits include dental care with no copay for preventive services and up to a $2,000 annual limit for comprehensive care, alongside a $200 annual eyewear allowance with no copay. Hearing exams and prescription hearing aids are also covered with fixed copays and no coinsurance, plus a $40 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Forever Blue 751 (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute care requires a $205 daily copay for days 1-7 and no copay for days 8 and beyond, but upgrades are not covered. Psychiatric care requires a $270 daily copay for days 1-6 and no copay for days 7-90, while additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Forever Blue 751 (PPO) outpatient services are covered with no coinsurance, featuring a $300 copay for outpatient hospital and observation services and a $200 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under the Forever Blue 751 (PPO) plan with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Forever Blue 751 (PPO) covers ground and air ambulance services with a $225 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Forever Blue 751 (PPO) 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 with no coinsurance, and worldwide emergency services are covered with no coinsurance and copays ranging from $50 to $225 depending on the service.
Primary Care See details
Primary care services under Forever Blue 751 (PPO) feature no coinsurance, with copays ranging from no copay to $5 for primary care visits and $25 for specialists. Chiropractic care is partially covered with a $15 copay for routine care, though other chiropractic services are not covered, while therapy, mental health, and podiatry services require copays up to $50 with no coinsurance.
Preventive Services See details
Preventive services under Forever Blue 751 (PPO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. However, additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Forever Blue 751 (PPO) covers hearing exams with a $25 to $45 copay and no coinsurance, and partially covers prescription hearing aids with a $499 to $799 copay and no coinsurance. No deductible applies to these services, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision Services under Forever Blue 751 (PPO) are partially covered, offering one routine eye exam per year with a $25 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing up to a $200 combined annual limit for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Forever Blue 751 (PPO) partially covers dental services, offering Medicare-covered dental for a $25 copay and no coinsurance, and preventive care with no copay and no coinsurance. Comprehensive services are covered with no copay and 0% to 50% coinsurance up to a $2,000 annual maximum, though other diagnostic services, fluoride, other preventive care, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Forever Blue 751 (PPO) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Forever Blue 751 (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Forever Blue 751 (PPO) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment is partially covered with no copay or coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Forever Blue 751 (PPO) subject to prior authorization, featuring no coinsurance for diagnostic tests alongside a $5 copay for lab services and a $40 copay for diagnostic procedures. For radiological services, members pay a $40 copay for outpatient X-rays, a minimum $150 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Forever Blue 751 (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Forever Blue 751 (PPO) covers some cardiac rehabilitation services with no coinsurance, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Forever Blue 751 (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not necessary, additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Forever Blue 751 (PPO) partially covers other services, offering over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance. Covered OTC items have a maximum benefit of $40 every three months, while acupuncture is not covered.
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