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Forever Blue 770 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Forever Blue 770 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Forever Blue 770 (PPO) in 2025, please refer to our full plan details page.
Forever Blue 770 (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2025 to people living in Northeastern New York. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Forever Blue 770 (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 770 (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 770 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $198.00. 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 770 (PPO) plan has an enhanced alternative drug benefit. This plan has a $0 deductible for prescription drugs, so you will not have to pay anything before your drug coverage begins. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will pay a $10 copay at a preferred pharmacy for preferred generic drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for your drugs.
Additional Benefits
The Forever Blue 770 (PPO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay, which varies based on the type of care and the length of stay. Outpatient services have copays, such as $275 for hospital services and $40 for substance abuse sessions. The plan also covers primary care visits with copays, hearing and vision services, and dental services. Other key benefits include home health services with no copay, and skilled nursing facility stays with a copay that varies based on the length of stay. The plan also offers coverage for emergency services, ambulance services, and other services such as over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Forever Blue 770 (PPO) plan. For Inpatient Hospital-Acute, you will pay a $205 copay for days 1-7, and then no copay for days 8-90; for Inpatient Hospital Psychiatric, you will pay a $270 copay for days 1-6, and then no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $275 copay, and observation services with a $275 copay. Ambulatory Surgical Center (ASC) Services have a $175 copay, while 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 770 (PPO) plan. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Forever Blue 770 (PPO) plan. Both ground and air ambulance services have a $300 copay, with no coinsurance. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency Services under the Forever Blue 770 (PPO) plan includes a $125 copay, while Urgently Needed Services has a $55 copay, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage, a $55 copay for Worldwide Urgent Coverage, and a $300 copay for Worldwide Emergency Transportation, all with no coinsurance. The emergency services copay is waived if admitted to the hospital within 1 day.
Primary Care See details
Primary Care Physician Services are covered with a copay between $0 and $5, Chiropractic Services are covered with a $15 copay, and Occupational Therapy Services, Physical Therapy, and Speech-Language Pathology Services are covered with a $15 copay. Physician Specialist Services have a $22 copay, while Mental Health, Psychiatric Services, and Opioid Treatment Program Services have a $40 copay. Additional Telehealth Benefits are covered with a copay between $0 and $55.
Preventive Services See details
Preventive services, including Medicare-covered services, annual physical exams, and additional preventive services such as health education, fitness benefits, enhanced disease management, telemonitoring services, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered. 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 of enrollees, additional sessions of smoking and tobacco cessation counseling, remote access technologies, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing Services are covered by the Forever Blue 770 (PPO) plan, including hearing exams with a $22 copay. Routine hearing exams have a copay of $45 and are limited to one per year, while fitting/evaluation for hearing aids has no copay. Prescription hearing aids (all types) are covered with a copay between $499 and $799, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Forever Blue 770 (PPO) plan covers vision services, including eye exams with a copay of $0-$22. Routine eye exams have a $25 copay, and eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
The Forever Blue 770 (PPO) plan covers dental services, including oral exams, dental x-rays, and cleaning, with a $22 copay for Medicare dental services. Other dental services such as fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services have a maximum benefit of $2,000 per year. Restorative, adjunctive general, endodontics, prosthodontics (removable and fixed), and oral/maxillofacial surgery services are covered with 50% coinsurance.
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, and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Forever Blue 770 (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, Prosthetics/Medical Supplies - Non-Medicare benefit with a coinsurance, and Diabetic Equipment, though Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered. Durable Medical Equipment for use outside the home is also not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures with a $40 copay, lab services with a $5 copay, diagnostic radiological services with a $150 copay, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $40 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Forever Blue 770 (PPO) 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 not covered by the Forever Blue 770 (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
The Forever Blue 770 (PPO) plan covers Skilled Nursing Facility (SNF) stays with a $0 copay for days 1-20, and a $214 copay for days 21-100, but does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. Prior authorization is required for this benefit.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items with a maximum benefit coverage amount of $65 every three months, and a meal benefit for chronic illness with no maximum coverage amount. 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, and Self-Directed Personal Assistance Services are not covered.
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