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Community Blue Medicare HMO Signature (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community Blue Medicare HMO Signature (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Community Blue Medicare HMO Signature (HMO) in 2026, please refer to our full plan details page.
Community Blue Medicare HMO Signature (HMO) is a HMO plan offered by Highmark Health available for enrollment in 2026 to people living in Western New York. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Community Blue Medicare HMO Signature (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Community Blue Medicare HMO Signature (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Community Blue Medicare HMO Signature (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6750.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Community Blue Medicare HMO Signature (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at preferred pharmacies, as well as for a 3-month supply through preferred mail order. Tier 2 generic prescriptions are also budget-friendly, costing a low $3 copay for a 1-month supply at a preferred pharmacy compared to a $20 copay at a standard pharmacy. Higher-tier medications under this plan are subject to coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. Utilizing preferred pharmacies and preferred mail order services provides the most cost-effective way to fill prescriptions under this plan.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers robust medical coverage featuring no copays or coinsurance for primary care visits, preventive services, home health care, and laboratory tests. For specialized medical needs, members will pay a $40 copay for specialist visits, a $130 copay for emergency care, and a $350 daily copay for the first six days of acute inpatient hospital stays. Outpatient services and surgeries generally require copays ranging from $275 to $375, both featuring no coinsurance. Additional benefits include routine dental and vision exams, featuring no copay for preventive dental care and a $25 copay for eye exams, alongside a $100 annual allowance for eyewear and a $1,500 limit on dental services. Skilled nursing facility stays require no copay for the first 20 days, while routine hearing exams require a $45 copay. The plan also covers over-the-counter items with no copay up to $75 every three months, and dialysis services are covered with a 20% coinsurance.
Inpatient Hospital See details
Community Blue Medicare HMO Signature (HMO) covers inpatient hospital services with no coinsurance, requiring a $350 copay for days 1-6 of acute stays and a $405 copay for days 1-4 of psychiatric stays, with no copays for subsequent days. This benefit is partially covered, as upgrades for acute stays as well as additional days and non-Medicare-covered stays for psychiatric care are not covered.
Outpatient Services See details
Community Blue Medicare HMO Signature (HMO) covers outpatient services with no coinsurance, featuring a $375 copay for outpatient hospital and daily observation services, and a $275 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $40 copay, while outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Community Blue Medicare HMO Signature (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Community Blue Medicare HMO Signature (HMO) covers ground and air ambulance services with a $390 copay and no coinsurance, subject to prior authorization. For transportation, some services are covered, but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Community Blue Medicare HMO Signature (HMO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within one day. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $130 for emergency care, $40 for urgent care, and $390 for emergency transportation.
Primary Care See details
Community Blue Medicare HMO Signature (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Physical, speech, and occupational therapies require a $30 copay and no coinsurance, while chiropractic benefits are partially covered, offering routine visits for a $15 copay with no coinsurance but excluding other chiropractic services. Other services like mental health, podiatry, and telehealth are covered with no coinsurance and copays ranging from $0 to $40.
Preventive Services See details
Community Blue Medicare HMO Signature (HMO) offers coverage for preventive services, including annual physical exams, kidney disease education, and diabetes self-management, with no copay and no coinsurance. While select benefits like memory fitness and remote access technologies are included, these additional preventive services are only partially covered, with exclusions such as health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Community Blue Medicare HMO Signature (HMO) covers hearing exams with no coinsurance, requiring a $45 copay for an annual routine exam and a $40 copay for fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999 for up to two devices yearly, while OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Community Blue Medicare HMO Signature (HMO) provides partially covered vision services, where other eye exam services are not covered but routine exams are covered with a $25 copay and no coinsurance. Eyewear is covered with no copay or coinsurance up to a $100 annual maximum for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Community Blue Medicare HMO Signature (HMO) offers partially covered dental services with a $1,500 annual limit, featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive care. Comprehensive services require no copay and 50% coinsurance (0% to 50% for adjunctive services), while implant services, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Community Blue Medicare HMO Signature (HMO) covers home infusion bundled services with no copay, requiring prior authorization. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Community Blue Medicare HMO Signature (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Community Blue Medicare HMO Signature (HMO) with no copays, but coinsurance ranges from 0% to 50% for durable medical equipment and is 20% for prosthetics and medical supplies, with prior authorization required. Diabetic equipment is partially covered with no copay or coinsurance, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Community Blue Medicare HMO Signature (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and procedures have no coinsurance and a $0 to $10 copay, lab services have no copay or coinsurance, and radiological services feature a $25 copay for X-rays, a minimum $200 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Community Blue Medicare HMO Signature (HMO) covers Home Health Services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered under Community Blue Medicare HMO Signature (HMO) with no coinsurance, although standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Community Blue Medicare HMO Signature (HMO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Other Services are partially covered under the Community Blue Medicare HMO Signature (HMO) plan, offering no copay and no coinsurance for chronic illness meal benefits and over-the-counter items up to $75 every three months. Acupuncture, nicotine replacement therapy, and naloxone are not covered.
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