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Senior Blue Basic (HMO)

NEW! Enjoy comprehensive medical and drug coverage, additional benefits, and get $50 back every month. This unique benefit comes with our Senior Blue Basic (HMO) plan and puts $50 back in your Social Security check every month.*

Plan Overview


Senior Blue Basic (HMO)



$0 Tiers 1-2
$350 Tiers 3-5

$400 per days 1-5
$2,000 OOP max per year





Senior Blue Basic (HMO) Plan Details

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Primary Care Doctor/Specialist

Primary Care Doctor Specialist
$15 $45
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Use our 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 (tiers 1-2) / $350 (tiers 3-5)
Part D Prescriptions: Preferred Pharmacy Standard Pharmacy
Tier 1 $4 $9
Tier 2 $12 $17
Tier 3 $42 $47
Tier 4 $94 $100
Tier 5 27% 27%

$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 2022 Medicare Formulary includes a list of prescription care drugs covered by a prescription drug plan.

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Surgery & Treatment

Inpatient hospital $400 per day for days 1-5
$2,000 OOP max per year
Outpatient hospital $475
Ambulatory surgery $425
X-rays $50
Advanced radiology $225
Lab $10
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Preventive Dental

All our plans include preventive dental coverage:

  • Routine cleanings/oral exams - one per year ($23 copay per service)
  • X-rays - four bitewing or one full-month X-ray per year ($23 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 $12 50% coinsurance $500
Enhanced $25 50% coinsurance $1,000
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Plan Highlights

Worldwide coverage for emergency/urgent care $90/$65
Part B diabetes supplies and monitors* $0
Skilled nursing facility days 1-20 $0
Skilled nursing facility days 21-100 $188/day
Hearing aid (specific models)** Not Covered
In-network out-of-pocket maximum $7,550

Explore Plan Details

Medicare Questions?

We're here to help.

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

*Beneficiaries are eligible for a Part B monthly premium giveback if they do not receive Medicaid or anyother assistance paying their Part B premium. Beneficiaries must continue paying their Part B premium.

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

Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY) is a trade name of Highmark Western and Northeastern New York Inc., an independent licensee of the Blue Cross Blue Shield Association. Highmark BCBSWNY is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal. Highmark 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 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).

Content last updated: October 1, 2021