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Forever Blue 751 (PPO)*

Our Forever Blue 751 (PPO) Medicare Advantage Plan is designed to make Medicare easy for you. 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.

New for 2020! New Blue Total Health Package

Live a healthy lifestyle with our additional Blue benefits and preventive services included in your Medicare Advantage plan.

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.

Forever Blue 751 (PPO)

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 $199.00

Plan Information

Doctors

Primary Care Doctor Specialist
$5 $27
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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
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. 

Prescription Drug Infomation
The 2020 Medicare Formulary includes a list of prescription care drugs covered by a prescription drug plan.

Surgery & Treatment

 
 
Inpatient hospital $205/day, days 1-7 / $1,435 max per year
Outpatient hospital $300
Ambulatory surgery $200
X-rays $40
Advanced radiology $150
Lab $5

Dental Coverage

All of our plans 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 $11 50% coinsurance $500
Enhanced $25 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 $178/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).

New Blue Total Health Package

Our Blue Total Health package provides you with the additional benefits and preventive services you want and need to help you live a healthy lifestyle. This exclusive benefits package includes:  

Preventive dental

Preventive dental coverage includes reimbursement for up to two cleanings, two exams, and one set of X-rays annually1. This benefit requires no network and can be used at any dental provider.

  • $10 copay per service

Vision2

  • $100 annual allowance on frames, lenses, and contacts through an EyeMed provider (not covered on BlueSaver HMO)
  • $25 annual routine eye exam through an EyeMed provider

Hearing

Save thousands on hearing aids through TruHearing.

  • $699 or $999 per unit3
  • $45 annual routine hearing exam through a TruHearing provider

Fitness

SilverSneakers® no-cost fitness benefit with access to 16,000+ fitness locations nationwide.

Rewards for preventive services

Earn up to $60 for annual preventive services including annual wellness visit, colon cancer screening, and breast cancer screening.4 Up to $60 total or one $20 Prepaid Card per service.

Low- or no-cost vaccines

  • $0 copay for preventive vaccines including flu, pneumonia, and hepatitis
  • Coverage for shingles vaccine with Tier 1 copay (copays vary by plan; not covered on Senior Blue 601 HMO)

Part B diabetic monitoring supplies

  • $0 Part B diabetic monitoring supplies including lancets, glucose monitors, and test strips

Unless otherwise noted, costs shown are for services received in-network.

Contracts & Additional Resources

Medicare Questions?

We're here to help.

1-833-735-4511 (TTY 711)
Oct. 1 - Dec. 31, 8 a.m. - 8 p.m., 7 days a week
Jan. 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.

BlueCross BlueShield of Western New York (BCBSWNY) is a division of HealthNow New York Inc., an independent licensee of the Blue Cross and Blue Shield Association. BCBSWNY 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 linguistica, 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) 

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Content Last Updated: October 15, 2019