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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 2026, 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 4.5 out of 5 stars in 2026.
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 $152.00. 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 Value (PPO) Medicare prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies, or for a 3-month supply through preferred mail order. Tier 2 generic drugs are also highly affordable, costing as little as a $3 copay for a 1-month supply at preferred pharmacies. For higher-tier medications, costs transition from flat copayments to coinsurance percentages. Tier 3 preferred brand drugs require a 20% coinsurance across all pharmacy types, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. Utilizing preferred pharmacies and preferred mail-order services offers the greatest overall savings on your prescription medication costs under this plan.
Additional Benefits
The Forever Blue Value (PPO) plan offers robust coverage for essential medical services, featuring no coinsurance for primary care, specialist visits, and hospital stays. Doctor visits are highly affordable, requiring a copay of up to $10 for primary care and $30 for specialists, while preventive services are available with no copay. If you require hospital care, inpatient acute stays have a $295 copay for the first seven days, and emergency room visits require a $130 copay which is waived upon admission. For extra wellness support, the plan provides no copay for home health services and the first 20 days of skilled nursing facility care. Supplemental benefits include preventive dental exams and cleanings with no copay, a $200 annual allowance for eyewear, and a $40 quarterly allowance for over-the-counter items. Hearing exams and prescription hearing aids are also covered with fixed copays and no coinsurance.
Inpatient Hospital See details
Forever Blue Value (PPO) covers inpatient hospital services with no coinsurance, requiring a $295 copay for days 1 to 7 of acute stays and a $270 copay for days 1 to 6 of psychiatric stays, with no copay for subsequent days. This benefit is partially covered because upgrades for acute stays, as well as additional days and non-Medicare-covered stays for psychiatric care, are not covered.
Outpatient Services See details
Forever Blue Value (PPO) covers outpatient hospital and observation services with a $350 copay and no coinsurance, and ambulatory surgical center services with a $250 copay and no coinsurance. Outpatient substance abuse services require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Forever Blue Value (PPO) with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance services under Forever Blue Value (PPO) are covered with a $320 copay and no coinsurance for both ground and air transport, though prior authorization is required. Additional transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Forever Blue Value (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within one day, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent services are also covered with no coinsurance, featuring copays of $130 for emergency care, $50 for urgent care, and $320 for emergency transportation.
Primary Care See details
Forever Blue Value (PPO) offers comprehensive primary care benefits with no coinsurance, featuring a copay of up to $10 for primary care visits and $30 for specialist visits. Other covered services like physical therapy, mental health, and telehealth require no coinsurance and copays ranging from no copay to $50, though chiropractic care is only partially covered as other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Forever Blue Value (PPO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive benefits are partially covered, offering memory fitness, enhanced disease management, and remote access technologies, while services like health education, weight management, personal emergency response systems, and in-home safety assessments are not covered.
Hearing Services See details
Forever Blue Value (PPO) partially covers hearing services, offering hearing exams with a $30 to $45 copay and no coinsurance, alongside prescription hearing aids with a $499 to $799 copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by Forever Blue Value (PPO), featuring a $25 copay and no coinsurance for an annual routine eye exam, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $200 annual maximum for frames, lenses, contacts, and upgrades.
Dental Services See details
Forever Blue Value (PPO) partially covers dental services, offering Medicare-covered dental for a $30 copay and no coinsurance, alongside preventive exams, cleanings, and x-rays with no copay and no coinsurance. Comprehensive services are covered up to a $2,000 annual limit with no copay and 50% coinsurance (0% to 50% for periodontics). Fluoride, other diagnostic or preventive dental, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled services are covered by Forever Blue Value (PPO) with no copay, though prior authorization and step therapy may be required. Associated Medicare Part B chemotherapy, radiation, and other drugs require coinsurance ranging from no coinsurance up to 20%, while covered Medicare Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered by the Forever Blue Value (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by Forever Blue Value (PPO), offering durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. While some diabetic equipment services are covered with no copay and no coinsurance, diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Forever Blue Value (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic procedures and lab services have no coinsurance, costing a $45 and $5 copay respectively. Radiological services require a $150 copay for diagnostic radiology, a $45 copay for X-rays, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the Forever Blue Value (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Forever Blue Value (PPO) does not cover Cardiac Rehabilitation Services, as all associated sub-services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation, are not covered in practice.
Skilled Nursing Facility (SNF) See details
Forever Blue Value (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Forever Blue Value (PPO) partially covers Other Services with no copay and no coinsurance, offering a meal benefit for chronic illnesses and a $40 allowance every three months for over-the-counter items. Acupuncture and other additional services in this category are not covered.
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