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Forever Blue 751 (PPO)

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.

PRIMARY/SPECIALTY
$5/$25

DRUG DEDUCTIBLES
$0

INPATIENT HOSPITAL
$205 per day for days 1-7,
$1,435 OOP Max per year

MONTHLY PREMIUM

$204

MONTHLY PREMIUM

$204

Forever Blue 770 (PPO) Plan Details

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Primary Care Doctor/Specialist

Primary Care Doctor Specialist
$5 $25
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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. 

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Part D 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%
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$0 Tier 1 Generics with Convenient Home Delivery

$0 copay for a 90-day supply of Tier 1 preferred generic medications delivered for free through Express Scripts® mail order during the initial coverage stage.

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 Information
The 2021 Medicare Formulary includes a list of prescription care drugs covered by a prescription drug plan.

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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
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Preventive Dental

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
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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 $184/day
Hearing aid (specific models)* $699 or $999/unit
In-network out-of-pocket maximum $6,700

This past January, the Centers for Medicare & Medicaid Services (CMS) added acupuncture as a covered benefit for Medicare patients with chronic low back pain. According to CMS, coverage will include "up to 12 sessions in 90 days with an additional 8 sessions for those patients with chronic low back pain who demonstrate improvement." Treatment must also be recommended and supervised by a doctor.

Explore Plan Details

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, 2020