Senior Blue 601 (HMO) Plan Details for Wyoming County, NY
This Highmark Blue Cross Blue Shield or Highmark Blue Shield plan has an overall rating of 4.0 (Good) out of 5 stars.
Senior Blue 601 (HMO) is a Medicare Advantage plan without a prescription drug plan. The 2025 enrollment period begins Oct. 15.
See more Medicare Advantage Plans in Wyoming County, New York.
2025 Senior Blue 601 Cost and Coverage Notification
The 2025 cost and coverage information for Senior Blue 601 will not be available until early October. We'll notify you as soon as it is available from CMS.
Sign-Up for 2025 Medicare Plan Notification. The 2025 Annual Enrollment Period begins October 15.
Senior Blue 601 Basic Details
| Plan Basics | |
|---|---|
| Plan ID: | H3384-022-0 |
| Plan Type: | Local HMO |
| Plan Year: | 2024 |
| Premium: | $0.00/mo Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $6,700/yr |
| Part B Reduction: | $0.00/mo |
| Drug Plan Benefit: | Not Included |
| Rx Gap Coverage: | No |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | Wyoming County, NY |
| Insured By: | Highmark Blue Cross Blue Shield or Highmark Blue Shield |
| Summary of Benefits |
|---|
Highmark Blue Cross Blue Shield or Highmark Blue Shield Out-of-Pocket Costs
This Highmark Blue Cross Blue Shield or Highmark Blue Shield Part C plan has cost-sharing. These are costs you pay out-of-pocket when you use approved health services. The following table summarizes the most common in-network out-of-pocket costs in plan H3384-022-0.
NOTE: Most preventive services are covered 100% by the plan as a Part B benefit.
| Healthcare Service | Member Cost |
|---|---|
| Doctor Visits (In-Network) | |
| Primary: | $5 Copay |
| Specialist: | $45 Copay |
| Wellness programs (e.g., fitness, nursing hotline): | None |
| Preventive care: | $0 |
| Foot Care (In-Network) | |
| Foot exams and treatment (Medicare-covered): | $45 Copay |
| Routine foot care: | $45 Copay |
| Chiropractic Care (In-Network) | |
| Medicare-covered chiropractic care: | $15 Copay |
| Routine chiropractic care: | Not Covered |
| Emergency Care / Urgent Care | |
| Emergency room care: | $100 Copay |
| Urgent care: | $55 Copay |
| Ground ambulance: | $200 Copay |
| Inpatient hospital coverage: | $290.00 per day for days 1 through 7 $0.00 per day for days 8 and beyond |
| Outpatient hospital coverage: | $225 Copay Prior Authorization Required |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $203.00 per day for days 21 and beyond |
| Optional supplemental benefits: | |
| Mental Health Services (In-Network) | |
| Outpatient individual therapy visit with a psychiatrist: | $40 Copay |
| Outpatient group therapy visit with a psychiatrist: | $40 Copay |
| Inpatient hospital - psychiatric: | $260.00 per day for days 1 through 6 $0.00 per day for days 7 and beyond |
| Outpatient group therapy visit: | $40 Copay |
| Outpatient individual therapy visit: | $0 |
| Rehabilitation Services (In-Network) | |
| Physical therapy and speech and language therapy visit: | $15 Copay |
| Occupational therapy visit: | $15 Copay |
| Medical Equipment / Supplies (In-Network) | |
| Diabetes supplies: | $0 |
| Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Prior Authorization Required |
| Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
| Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
| Diagnostic radiology services (e.g., MRI): | $150 Copay Prior Authorization Required |
| Lab services: | $0 |
| Outpatient x-rays: | $45 Copay Prior Authorization Required |
| Diagnostic tests and procedures: | $45 Copay Prior Authorization Required |
| Medicare Part B Drugs (In-Network) | |
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our Senior Blue 601 Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits Highmark Blue Cross Blue Shield or Highmark Blue Shield includes with this plan:
| Supplemental Healthcare Service | Member Cost |
|---|---|
| Preventive Dental | |
| Oral exam (In-Network) | Not Covered |
| Fluoride treatment (In-Network) | Not Covered |
| Dental x-ray(s) (In-Network) | Not Covered |
| Cleaning (In-Network) | Not Covered |
| Comprehensive Dental | |
| Periodontics (In-Network) | Not Covered |
| Non-routine services (In-Network) | Not Covered |
| Diagnostic services (In-Network) | Not Covered |
| Extractions (In-Network) | Not Covered |
| Endodontics (In-Network) | Not Covered |
| Restorative services (In-Network) | Not Covered |
| Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
| Hearing Aids | |
| Fitting/evaluation (In-Network) | Covered Limits may apply |
| Hearing aids (In-Network) | Covered Limits may apply |
| Hearing exam (In-Network) | $45 Copay |
| Vision | Maximum vision benefit: | $100.00 Every year |
| Eyeglasses (frames and lenses) (In-Network) | Covered Limits may apply |
| Routine eye exam (In-Network) | $25 Copay |
| Contact lenses (In-Network) | Covered Limits may apply |
Additional Benefits
None specified.
Prescription Drug Plan Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Rating Marks
The following table shows the quality ratings for this Highmark Blue Cross Blue Shield or Highmark Blue Shield plan. Each year CMS rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories using a 5-star rating system. Here are the most recent ratings for Senior Blue 601.
| CMS Measure | Star Rating |
|---|---|
| 2024 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Additional Plan Options
The Medicare Part C program offers a myriad of HMO, PPO, and PFFS plan options, including these plans:
- Freedom Value
- Senior Blue 652
- Senior Blue 601
- BlueSaver
- Senior Blue Select
- Senior Blue 651
- Senior Blue Basic
If you are enrolled in a Part C plan with prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D plan, regardless of your chosen insurance company.
You cannot be enrolled in a Part C health plan and simultaneously hold Medicare Supplement Insurance (Medigap). Medicare Supplement plans are only compatible with Medicare Parts A and B.
Contact Highmark Blue Cross Blue Shield or Highmark Blue Shield
| Plan Website: | http://medicare.highmark.com |
|---|---|
| Formulary Information: | http://medicare.highmark.com |
| Pharmacy Information: | Highmark Blue Cross Blue Shield or Highmark Blue Shield Pharmacy Page |
| Prospective Members: | (855)856-8348 |
| TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Part C program on www.medicare.gov or call 1-800-MEDICARE.
Citations & References
- Highmark Blue Cross Blue Shield or Highmark Blue Shield, http://medicare.highmark.com, Last Accessed February 20, 2024
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed January 21, 2024
- Medicare.gov, "Compare Original Medicare & Medicare Advantage", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You Handbook", Last Accessed February 19, 2024
- Medicare.gov, "Your Medicare Coverage", Last Accessed April 11, 2023
- CMS.gov, Landscape Source Files, Last Accessed February 21, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed February 21, 2024
- CMS.gov, Plan Benefits Package, Last Accessed February 21, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.