2018 Senior Blue HMO Medicare Advantage Plans

 

Our BlueSaver (HMO) and Senior Blue (HMO) Medicare Advantage Plans are designed to make Medicare easy for you.  With no cost or low cost monthly premiums and coverage that's recognized nationwide, you can rest easy knowing that you're covered and your claims will be paid with no work on your part. 

Not sure if this plan is right for you?  Call us, visit one of our Medicare Centers, chat online, or click the button below, and we'll help you find the right plan. 

*If you need a different format, please view our Multi-Language Interpreter Services

 

PLANS BlueSaver (HMO) Senior Blue 601 (HMO)
2018 premium* $0 $0
Out-of-pocket (OOP) maximum $6,700  $6,700

Medical

Deductible

None None
Primary doctor/Specialist $15/$41 $10/$45
Inpatient hospital $360 per day
$1,800 OOP limit per year
$280 per day
$1,960 OOP limit per year
Lab $10 $0
X-rays/advanced radiology $50/$175 $45/$75
Urgent care (copay waived if admitted) $65 $65
Emergency room visit (copay waived if admitted) $80 $80
Outpatient/Ambulatory surgery $500/$450 $300/$225
Preventive services $0 $0
Annual routine eye exam $41 $45
Vision wear (frames/lenses/contact lens) not covered $100 annual allowance
Hearing aid (coverage for specific models only; must use a Truhearing provider) $699 or $999/unit $699 or $999/unit
Optional supplemental dental plan*** Add to plan for additional 
$17 per month for the Basic plan, or $35 a month for the Enhanced plan
Add to plan for additional $17 per month for the
Basic plan, or $35 a month for the Enhanced plan
Nationwide coverage ER, urgent care, and dialysis ER, urgent care, and dialysis
Prescription drugs (30-day supply at a retail pharmacy):
Preferred pharmacies include Rite Aid and Walmart; see Provider Directory for a full list.
Prescription Drug Deductible

$0 Tiers 1-2

$290 Tiers 3-5 

 
Tier 1 - Preferred generic $2 Preferred Pharmacy, $7 Standard Pharmacy Not covered
Tier 2 - Generic $12 Preferred Pharmacy, $17 Standard Pharmacy Not covered
Tier 3 - Preferred brand $42 Preferred Pharmacy, $47 Standard Pharmacy Not covered
Tier 4 - Non-preferred brand $85 Preferred Pharmacy, $90 Standard Pharmacy Not covered
Tier 5 - Specialty 27% Preferred Pharmacy, 27% Standard Pharmacy Not covered
Gap coverage Discounts Not covered
PLANS Senior Blue Select (HMO) Senior Blue 651 (HMO)
2018 premium* $46 $117
Out-of-pocket (OOP) maximum $6,700 $6,700

Medical

Deductible

None None
Primary doctor/Specialist $10/$30 $0/$25
Inpatient hospital $280 per day
$1,960 OOP limit per year
$225 per day
$1,575 OOP limit per year
Lab $10 $5
X-rays/advanced radiology $50/$175 $40/$75
Urgent care (copay waived if admitted) $65 $65
Emergency room visit (copay waived if admitted) $80 $80
Outpatient/Ambulatory surgery $375/$300 $300/$225
Preventive services $0 $0
Annual routine eye exam $30  $25
Vision wear (frames/lenses/contact lens) $100 annual allowance $100 annual allowance
Hearing aid (coverage for specific models only; must use a TruHearing provider) $699 or $999/unit $699 or $999/unit
Optional supplemental dental plan*** Add to plan for additional $17 per month for the
Basic plan, or $35 a month for the Enhanced plan
Add to plan for additional
$17 per month for the
Basic plan, or $35 a month for the Enhanced plan
Nationwide coverage ER, urgent care, and dialysis ER, urgent care, and dialysis
Prescription drugs (30-day supply at a retail pharmacy):
Preferred pharmacies include Rite Aid and Walmart; see Provider Directory for a full list.
Prescription Drug Deductible

$0 Tiers 1-2

$180 Tiers 3-5 

$0
Tier 1 - Preferred generic $2 Preferred Pharmacy, $7 Standard Pharmacy $4 Preferred Pharmacy, $9 Standard Pharmacy
Tier 2 - Generic $10 Preferred Pharmacy, $15 Standard Pharmacy $10 Preferred Pharmacy, $15 Standard Pharmacy
Tier 3 - Preferred brand $42 Preferred Pharmacy, $47 Standard Pharmacy $42 Preferred Pharmacy, $47 Standard Pharmacy
Tier 4 - Non-preferred brand $94 Preferred Pharmacy, $100 Standard Pharmacy $94 Preferred Pharmacy, $100 Standard Pharmacy
Tier 5 - Specialty 29% Preferred Pharmacy, 29% Standard Pharmacy 33% Preferred Pharmacy, 33% Standard Pharmacy
Gap coverage Discounts Discounts and tier 1 generic coverage through the gap

*You must continue to pay your Medicare Part B premium.

***Dental premium is in addition to plan and Part B premium. 

Our plans cover one routine hearing exam per year with a TruHearing™ provider. Please call TruHearing to verify your benefit and schedule a hearing exam. Coverage is for TruHearing Flyte models only. TruHearing™ is a registered trademark of TruHearing, Inc. TruHearing is an independent company that administers the hearing-aid benefit. 

You must live in one of the following Western New York counties to be eligible for enrollment in one of our Medicare Advantage plans:

  • Allegany
  • Genesee
  • Cattaraugus
  • Niagara
  • Chautauqua
  • Orleans
  • Erie
  • Wyoming

Enrolling is easy! You can use our online enrollment system or print off, complete and mail in the paper-based application. 

Medicare beneficiaries may also enroll in Senior Blue HMO or Forever Blue Medicare PPO through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

adobe reader icon Senior Blue Paper Based Application

 

Need Assistance?

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1-800-248-9296  (TTY 711)

Oct. 1 - Feb. 14, 8 a.m. to 8 p.m., 7 days a week
Feb. 15 - Sept. 30, 8 a.m. - 8 p.m., Mon. - Fri.

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This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B Premium.

Out-of-network/non-contracted providers are under no obligation to treat BlueCross BlueShield of Western New York members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. 

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

BlueCross BlueShield of Western New York is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal.

A division of HealthNow New York Inc., and independent licensee of the BlueCross BlueShield Association. A salesperson will be present with information and applications. For accommodations of persons with special needs at sales meetings, please call 1-800-329-2792 (TTY 711). BlueCross BlueShield of Western New York complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-329-2792 (TTY: 711).

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-800-329-2792 (TTY: 711).

Y0086_MRK1961 Approved
Content Last Updated October 1, 2017

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