Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H3384-013-000

Senior Blue 652 (HMO) · Highmark Blue Cross Blue Shield or Highmark Blue Shield · Northeastern New York

Compact plan code: H3384013000

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Senior Blue 652 (HMO)

H3384-013-000 Northeastern New York HMO
Open in quick lookup
01

In-network

Inpatient hospital

Days 1–7 $225 / day
Days 8–90 $0 / day
Total of listed copays · 7 charged days $1,575
02

Emergency transport

Ambulance

Ground · in-network$200 copay
Air · in-network$200 copay
03

Emergency services

Emergency room

$130 copay

Waived if admitted

04

Medical maximum

Maximum out-of-pocket

In-network$6,700
Combined in + outNot reported
05

Skilled care at home

Home health

In-networkNo cost share reported
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premium$103.60 / month
Consolidated C + D$104 / month

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release. Quick-reference values should be confirmed in current official plan documents.

PBP benefits ↗ Landscape data ↗

Same CMS contract

H3384-019-000 Senior Blue 651 (HMO) Western New York · HMO H3384-022-000 Senior Blue 601 (HMO) Western New York · HMO H3384-069-001 Community Blue Medicare HMO Signature (HMO) Buffalo Metro · HMO H3384-069-002 Community Blue Medicare HMO Signature (HMO) WNY Southern counties · HMO H3384-069-003 Community Blue Medicare HMO Signature (HMO) Western NY Rural counties · HMO H3384-070-001 Community Blue Medicare HMO Distinct (HMO) Buffalo Metro · HMO H3384-070-002 Community Blue Medicare HMO Distinct (HMO) WNY Southern counties · HMO H3384-070-003 Community Blue Medicare HMO Distinct (HMO) Western NY Rural counties · HMO

About this code

What H3384-013-000 identifies

H3384-013-000 is a Contract Year 2026 Medicare plan segment code. The compact form H3384013000 refers to the same normalized contract, plan, and segment shown on this page.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.