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Forever Blue Value (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Forever Blue Value (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Forever Blue Value (PPO) in 2025, please refer to our full plan details page.
Forever Blue Value (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 Value (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 Value (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 Value (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $131.00. 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 Value (PPO) plan has an "Enhanced Alternative" drug benefit. This plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For example, a preferred generic drug has a $10 copay at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Forever Blue Value (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. You'll find coverage for primary care visits, specialist services, and mental health, along with preventive services and some vision and dental care. The plan also provides coverage for ambulance and emergency services, as well as home health and skilled nursing facility care. Additionally, there's coverage for hearing exams, eyewear, and over-the-counter items. However, some services like cardiac rehabilitation, acupuncture, and certain dental procedures are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-7 and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you will pay a $270 copay for days 1-6 and no copay for days 7-90.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, with a $350 copay, and observation services, with a $350 copay. Ambulatory Surgical Center (ASC) Services have a $250 copay, and outpatient substance abuse services have a $40 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Forever Blue Value (PPO) plan. The plan has a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a $250 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. 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 $250 copay.
Primary Care See details
The Forever Blue Value (PPO) plan covers primary care physician services with a copay between $0 and $10, chiropractic services with a $15 copay, and occupational therapy services with a $20 copay. The plan also covers physician specialist services with a $30 copay, mental health specialty services with a $40 copay for individual and group sessions, and podiatry services with a $30 copay. Additionally, other health care professional services have a copay between $0 and $30, psychiatric services have a $40 copay for individual and group sessions, and physical therapy and speech-language pathology services have a $20 copay. The plan also covers additional telehealth benefits with a copay between $0 and $55, and opioid treatment program services with a $40 copay.
Preventive Services See details
The Forever Blue Value (PPO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, health education, fitness benefits (Memory Fitness), enhanced disease management, telemonitoring services, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking and tobacco cessation counseling, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
The Forever Blue Value (PPO) plan covers hearing exams with a $30 copay, and fitting/evaluation for hearing aids with no copay, but does not cover prescription hearing aids - inner ear, outer ear, or over the ear - nor does it cover OTC hearing aids. The plan also covers prescription hearing aids (all types) with a copay between $499 and $799.
Vision Services See details
The Forever Blue Value (PPO) plan covers vision services, including eye exams with a copay of $0-$30, routine eye exams with a $25 copay, and eyewear with a combined maximum of $200 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, and other dental services, including oral exams and dental x-rays, with specific limitations on the number of visits and periodicity. Fluoride treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered; Restorative Services, Adjunctive General Services, Endodontics, Prosthodontics, fixed, and Oral and Maxillofacial Surgery have a 50% coinsurance, while Periodontics have 0-50% coinsurance. Orthodontic Services are covered up to a $2,000 annual maximum.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay with coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Forever Blue Value (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance and no copay, and Prosthetic Devices and Medical Supplies with 20% coinsurance and no copay. Diabetic Equipment is partially covered, with only Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a $45 copay, Lab Services with a $5 copay, and Diagnostic Radiological Services with a $150 copay. Therapeutic Radiological Services have a 20% coinsurance, while Outpatient X-Ray Services have a $45 copay.
Home Health Services See details
Home Health Services are covered by the Forever Blue Value (PPO) plan with no copay and no coinsurance. However, 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 Value (PPO) 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 under the Forever Blue Value (PPO) plan, but require prior authorization. There is no copay for days 1-20, but there is a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Forever Blue Value (PPO) plan does not cover 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, or Self-Directed Personal Assistance Services. Over-the-counter (OTC) items are covered with a maximum plan benefit coverage amount of $60 every three months. The plan also covers meal benefits for chronic illnesses.
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