Skip to main content

Forever Blue 751 (PPO)*

Our Forever Blue 751 (PPO) Medicare Advantage Plan is designed to make Medicare easy for you. New for 2019, this plan includes preventive dental coverage. You can also pay in-network copays for all plan-covered services when you receive care outside of Western New York with BlueCard® Travel. It is designed to give you the freedom to see any doctor or hospital that accepts Medicare nationwide: 

BlueCard® Network Sharing Program

All of our plans cover you worldwide but if you travel often, you can enjoy flexibility with the BlueCard® Network Sharing Program through this plan. 

  • Links BlueCross plans and simplifies billing.
  • Pay the same as you would in-network for all plan-covered services outside of Western New York in participating areas.**
  • Find out if a doctor or facility participates in this program by calling 1-800-810-BLUE (2583) and select option 2.
**In order for services to be considered in-network while you're outside of the service area, the provider must participate with the local BlueCard® network sharing program in the service area and both you and the provider must be located in the same area when you receive care. Outside the U.S. you may be asked to pay 100% of the cost at the time of travel. You would then submit a claim to us to be reimbursed for your in-network cost-share.

Want to learn more about this plan?

Call us, visit one of our Medicare Centers, or chat online.

 

*Costs may be higher when out-of-network.

Forever Blue 751

Pay in-network copays for all plan-covered services when you receive care outside of Western New York with BlueCard travel.

Your Estimated Monthly Premium $197.00

Plan Information

Doctors

Primary Care Doctor Specialist
$5 $27
Light bulb

Use our new Find a Doctor tool to discover if your doctor, specialist, or facility are in-network.

If they are not in-network, you can search to find one that is in our network of providers. 

Prescription Drugs

 
 
Drug Deductibles  $0 / $0 (tiers 3-5)
Part D Prescriptions: Preferred Pharmacy Standard Pharmacy
Tier 1 $2 $7
Tier 2 $8 $13
Tier 3 $42 $47
Tier 4 $94 $99
Tier 5 33% 33%

The Medicare Part D Coverage Gap
The 'coverage gap' or 'donut hole' is a Part D drug coverage stage the changes what you pay for prescriptions. You may not end up in the coverage gap each year, but you should be aware of how it works, just in case. 

Surgery & Treatment

 
 
Inpatient hospital $205/day, days 1-7 / $1,435 max per year
Outpatient hospital $275
Ambulatory surgery $200
X-rays $40
Advanced radiology $75
Lab $5

Dental Coverage

NEW Preventive Dental:

All of our plans now include preventive dental coverage:

  • Routine cleanings/oral exams - twice per year ($10 copay per service).
  • X-rays - four bitewing or one full-month X-ray per year ($10 copay per service).

 

Optional Supplemental Dental is also available:

You may add dental care with the following optional supplemental benefits (no network - see any dentist):

 
Premium Diagnostic and Restorative Service Cost Annual Max Allowance
Basic $9 50% coinsurance $500
Enhanced $24 50% coinsurance $1,000

Plan Highlights

 
 
World coverage for emergency and urgent care $90/$65
Part B diabetes supplies and monitors $0
Skilled nursing facility days 1-20 $0
Skilled nursing facility days 21-100 $172.00/day
Hearing aid (specific models)* $699 or $999/unit
In-network out-of-pocket maximum $6,700

*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. Hearing aid $699 or $999/unit (one per ear, per year, specific models).

Plan Perks

What's Included: 
 

New! Up to $60 in Rewards: 

Members get a $20 reward card (up to $60) each after receiving certain preventive services, including their annual wellness visit, colorectal cancer screening, and breast cancer screening (subject to medical necessity).
 

Free Preventive Services: 

More than 20 services are included at no cost* when you use providers in our network. These services include annual wellness visit, bone density test, cardiovascular screenings, cancer screenings, diabetes self-management training, vaccines, and more. 

Free Gym Membership:

Stay active with access to more than 14,000 fitness locations nationwide with SilverSneakers®. Enjoy amenities including weight machines, cardio equipment, swimming pools, saunas, exercise classes for all fitness levels, and more. 

New! Telemedicine

Medicare Advantage members now have access to Telemedicine, hosted by Doctor On Demand. Connect with a doctor 24/7 from your mobile device, tablet, or computer for only $5 more than your primary doctor cost-share.

$0 Care Management: 

Our nationally accredited care management team works with you and your doctor to help manage your health and meet your unique goals.

Care at Home:

We've partnered with Landmark Health to create Care at Home -- care and support available 24/7, provided in the comfort of your home. 

Contracts & Additional Resources

Medicare Questions?

We're here to help.

1-833-735-4511 (TTY 711)
Oct. 1 - Mar. 31, 8 a.m. - 8 p.m., 7 days a week
Apr. 1 - Sept. 30, 8 a.m. to 8 p.m., Monday - Friday

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

*In order for services to be considered in-network while you’re outside of the service area, the provider must participate with the local BlueCard network sharing program in the service area and both you and the provider must be located in the same service area when you receive care. Outside the U.S. you may be asked to pay 100% of the cost at the time of service. You would then submit a claim to us to be reimbursed for your in-network cost-share.

 

A division of HealthNow New York Inc., an independent licensee of the BlueCross BlueShield Association. BlueCross BlueShield of Western New York is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal. This information is not a complete description of benefits. Call 1-800-329-2792 for more information. Out-of-network/non-contracted providers are under no obligation to treat BlueCross BlueShield of Western New York members; except in emergency situations. 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. 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 1-833-735-4515 (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 1-833-735-4515 (TTY: 711).

Y0086_MRK2318rev
Content Last Updated October 1, 2018.