Senior Blue 651 (HMO)

4 out of 5 stars
$97.00
Monthly Premium

Senior Blue 651 (HMO) is a HMO plan offered by Highmark Health

Plan ID: H3384-019

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.

Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.

Learn more about Medicare Advantage plans such as Senior Blue 651 (HMO) - H3384-019 by Highmark Health as well as other Medicare Advantage plans available in your area.

$97.00
Monthly Premium

New York Counties Served

AlleganyBergenCattaraugusChautauquaErieGeneseeNiagaraOrleansWyoming

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $615
Out of Pocket Max In-Network: $6700
Out-of-Network: N/A
Initial Coverage Limit $0
Catastrophic Coverage Limit $2100
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $25
Inpatient Hospital Care
In-Network:

Acute Hospital Services:
$225 per day for days 1 to 7
$0 per day for days 8 to 90
Maximum out of Pocket $1,575 every year
Prior Authorization Required for Acute Hospital Services
Urgent Care

Urgent Care:
Copayment for Urgent Care $50

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $50
Emergency Room Visit

Emergency Care:
Copayment for Emergency Care $130

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $130
Copayment for Worldwide Emergency Transportation $200
Ambulance Transportation
In-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $200

Air Ambulance:
Copayment for Air Ambulance Services $200
Prior Authorization Required for Air Ambulance

Health Care Services and Medical Supplies

Senior Blue 651 (HMO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:

Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $15
Copayment for Routine Care $15
  • Maximum 12 Routine Care every year
Diabetes Supplies, Training, Nutrition Therapy and Monitoring

In-Network:

Diabetic Supplies and Services:
Copayment for Medicare-covered Diabetic Supplies $0
Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0
Diabetic glucometer, test strip, and lancet brands dispensed via retail or mail order pharmacy are limited to Abbott and Trividia. Continuous glucose monitors, sensors and transmitters dispensed via retail or mail order pharmacy are limited to Abbott and Dexcom. All other desired brands will need to be obtained via an exception process or from a Durable Medical Equipment (DME) supplier.
Durable Medical Equipment (DME)
In-Network:

Durable Medical Equipment:
Coinsurance for Medicare-covered Durable Medical Equipment 0% to 20%
Prior Authorization Required for Durable Medical Equipment
0% coinsurance for compression stockings, 20% for all other DME items
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $40
Copayment for Medicare-covered Lab Services $5
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services

Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $150
Coinsurance for Medicare-covered Therapeutic Radiological Services 20%
Copayment for Medicare-covered X-Ray Services $40
Home Health Care
In-Network:

Home Health Services:
Copayment for Medicare-covered Home Health Services $0
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$215 per day for days 1 to 6
$0 per day for days 7 to 90
Prior Authorization Required for Psychiatric Hospital Services
Mental Health Outpatient Care
In-Network:

Outpatient Mental Health Services:
Copayment for Medicare-covered Individual Sessions $40
Copayment for Medicare-covered Group Sessions $40
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $325
Prior Authorization Required for Outpatient Hospital Services

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services - Per day $325

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $225
Prior Authorization Required for Ambulatory Surgical Center Services
Outpatient Substance Abuse Care
In-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $40
Copayment for Medicare-covered Group Sessions $40
Over-the-counter (OTC) Items
In-Network:

Over-The-Counter (OTC) Items:
Copayment for Over-The-Counter (OTC) Items $0
  • Maximum plan benefit of $40.00 every three months for Over-The-Counter (OTC) Items
Maximum Plan Benefit of $40 every three months
An OTC catalog of CMS-approved non-prescription over-the-counter medications and health-related items is available. Quantity limits and plan restrictions may apply.
Podiatry Services
In-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $25
Copayment for Routine Foot Care $25
  • Maximum 3 visits every year
Skilled Nursing Facility Care
In-Network:

Skilled Nursing Facility Services:
$0 per day for days 1 to 20
$218 per day for days 21 to 100
Prior Authorization Required for Skilled Nursing Facility Services

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care

In-Network:

Medicare Covered Dental:
Copayment for Office Visit $25

Non-Medicare Covered Preventive Dental:
Copayment for Oral exams $0

  • Maximum 2 visits every year

Copayment for Dental x-rays $0

  • Maximum 1 visit every year

Copayment for Prophylaxis $0

  • Maximum 2 visits every year


Non-Medicare Covered Comprehensive Dental:
Coinsurance for Restorative services 50%

Coinsurance for Endodontics 50%

Coinsurance for Periodontics 0% to 50%

Coinsurance for Prothodontics, removable 50%

Coinsurance for Prothodontics, fixed 50%

Coinsurance for Maxillofacial surgery 50%

Coinsurance for Adjunctive general services 50%

Maximum Plan Benefit of $2,000 every year

Please see Evidence of Coverage for details

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network:

Eye Exams:
Copayment for Medicare Covered Benefits $0 to $25
Copayment for Routine Eye Exams $25
  • Maximum 1 Routine Eye Exams every year
$0 for annual diabetic retinal diagnostic eye exam. All other diagnostic eye exams will charge a copay.

Eyewear:
Copayment for Medicare-Covered Benefits $0
Copayment for Contact Lenses $0
Copayment for Eyeglasses (lenses and frames) $0
Copayment for Eyeglass Lenses $0
Copayment for Eyeglass Frames $0
Copayment for Upgrades $0
Maximum Plan Benefit of $200 every year
We are offering a supplemental benefit to members which provides a $200 vision allowance to use towards glasses/frames/lenses/contacts.

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $25
Copayment for Routine Hearing Exams $45
  • Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0
Each hearing aid purchase includes one year of follow-up provider visits for fitting and adjustments. These visits are available for 12 months following hearing aid purchase and only with the purchase of a hearing aid.

Hearing Aids:
Copayment for Hearing Aids $499 to $799
  • Maximum 2 Hearing Aids every year
Members must use our contracted provider to use this benefit. Up to two hearing aids every year (one per ear per year). Benefit is limited to the Advanced (minimum cost sharing) and Premium (maximum cost sharing) hearing aids, which come in various styles and colors, and are available in rechargeable style options at no additional charge. Hearing aid purchase includes:- First year of follow-up provider visits- 60-day trial period- 3-year extended warranty- 80 batteries per aid for non-rechargeable models Benefit does not include or cover any of the following:

• Additional cost for optional hearing aid rechargeability

• Ear molds

• Hearing aid accessories

• Additional provider visits

• Additional batteries - batteries when a rechargeable hearing aid is purchased

• Hearing aids that are not TruHearing-branded hearing aids

• Costs associated with loss & damage warranty claims Costs associated with excluded items are the responsibility of the member and not covered by the plan.Services not covered under any condition:Hearing aids and provider visits to service hearing aids (except as specifically described in the Covered Benefits), ear molds, hearing aid accessories, warranty claim fees, and hearing aid batteries (beyond the 80 free batteries per non-rechargeable aid purchased).

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
Tobacco use cessation
Yearly "Wellness" visit

Prescription Drug Costs and Coverage

The Senior Blue 651 (HMO) plan offers the following prescription drug coverage, with an annual drug deductible of $615 (excludes Tiers 1 and 2) per year.

Coverage Cost
Coverage & Cost
Annual Drug Deductible $615 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share mail order N/A
  • Standard retail $7.00
  • Standard mail order N/A
  • Preferred cost-share retail $0.00
Generic
  • Preferred cost-share mail order N/A
  • Standard retail $15.00
  • Standard mail order N/A
  • Preferred cost-share retail $3.00
Annual Drug Deductible $615 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share mail order N/A
  • Standard retail N/A
  • Standard mail order N/A
  • Preferred cost-share retail N/A
Generic
  • Preferred cost-share mail order N/A
  • Standard retail N/A
  • Standard mail order N/A
  • Preferred cost-share retail N/A
Annual Drug Deductible $615 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $21.00
  • Standard mail order $21.00
  • Preferred cost-share retail $0.00
Generic
  • Preferred cost-share mail order $7.00
  • Standard retail $45.00
  • Standard mail order $45.00
  • Preferred cost-share retail $9.00
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