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Forever Blue 770 (PPO)

Our Forever Blue 770 (PPO) Medicare Advantage plan is designed to make Medicare easy for you.  Forever Blue 770 is designed to give you the freedom to see any doctor or hospital that accepts Medicare nationwide. 

 

If you see a participating BlueCard® provider outside of the service area, you pay your in-network copay. If you receive care from out-of-network providers, your cost may be higher. 

Not sure if this plan is right for you?

Call our customer service team, or chat online.

Forever Blue 770 (PPO)

This plan allows you to pay in-network copays with participating doctors or hospitals when you travel.

Your Estimated Monthly Premium $184.00

Doctors

Primary Care Doctor Specialist
$10 $22
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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

 
 
Medical / Drug Deductibles  $0 / $0 (tiers 3-5)
Part D Prescriptions: Preferred Pharmacy Standard Pharmacy
Tier 1 $2 $7
Tier 2 $12 $17
Tier 3 $42 $47
Tier 4 $94 $100
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 and Treatment

 
 
Inpatient hospital $205/day, days 1-7 / $1,435 max per year
Outpatient hospital $225
Ambulatory surgery $175
X-rays $40
Advanced radiology $100
Lab $5

Optional Supplemental Dental Care

Add Dental Care
Optional supplemental benefits (no network - see any dentist)

 
Premium Preventive Services (2 cleanings & 2 oral exams/year) Diagnostic and Restorative Service Cost Annual Max Allowance
Basic $19 50% coinsurance 50% coinsurance $500
Enhanced $38 Full coverage 50% coinsurance $1,000

Common Plan Elements

 
 
World coverage for emergency and urgent care  
Part B diabetes supplies and monitors $0
Skilled nursing facility days 1-20 $0
Skilled nursing facility days 21-100 $167.50/day
Hearing aid (specific models)* $699 or $999/unit
In-network out-of-pocket maximum $5,500

*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. Coverage is for TruHearing Flyte models only. TruHearing is a registered trademark of TruHearing, Inc. TruHearing is an independent company that administers the hearing aid benefit. 

Plan Perks

What's Included: 

$0 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. 

$0 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. 

$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.

$0 In-Home Care:

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 and Additional Resources

Medicare Questions?

We're here to help.

1-833-735-4512 (TTY 711)
Oct. 1 - Mar. 31, 8 a.m. - 8 p.m., 7 days a week
Apr. 1 - Sept. 30, 8 a.m. - 8 p.m., Monday - Friday

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

BlueShield of Northeastern New York is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal. A division of HealthNow New York Inc., an independent licensee of the BlueCross BlueShield Association.  A division of HealthNow New York Inc., an independent licensee of the BlueCross BlueShield Association. BlueShield of Northeastern 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).

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Content Last Updated October 1, 2018