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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, you pay no copay for a 1-month or 3-month supply at preferred pharmacies or through preferred mail order. Tier 2 generic drugs are also highly affordable, costing a $3.00 copay for a 1-month supply at preferred pharmacies compared to a $20.00 copay at standard pharmacies. Brand-name and specialty medications are subject to coinsurance rather than flat copayments under this plan. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance for a 1-month supply at both preferred and standard pharmacies. Utilizing preferred pharmacies and preferred mail-order services offers the most cost-effective way to fill prescriptions under this plan.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers robust core medical coverage featuring no copay or coinsurance for primary care visits and covered preventive services. For inpatient hospital stays, members pay a daily copay for the first few days with no coinsurance, while outpatient hospital services require a $425 daily copay. Emergency care is covered with a $130 copay, which is waived if admitted, and urgent care requires a $40 copay. This plan also includes essential supplemental benefits, such as dental care with no copay for preventive services and a $1,500 annual maximum for non-Medicare dental services. Vision care includes a $25 copay for routine annual exams and up to $100 annually for eyewear with no copay, while hearing exams and hearing aids are covered with fixed copays. Additionally, members benefit from no copay for home health services and receive a $75 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Community Blue Medicare HMO Signature (HMO) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $395 for days 1 to 6 of acute stays (no copay for days 7 and beyond) and $405 for days 1 to 4 of psychiatric stays (no copay for days 5 to 90). Room upgrades for acute care, 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, including a $425 copay per day for outpatient hospital and observation services and a $325 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Community Blue Medicare HMO Signature (HMO) 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, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Community Blue Medicare HMO Signature (HMO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within one day, and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered with no coinsurance and copays of $130, $40, and $390 respectively.
Primary Care See details
Community Blue Medicare HMO Signature (HMO) provides primary care physician services with no copay and no coinsurance, while specialist, therapy, and mental health services have copays ranging from $0 to $40 and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, as other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Community Blue Medicare HMO Signature (HMO) with no copay and no coinsurance for covered services like annual physicals, kidney disease education, and memory fitness. However, several supplemental benefits are not covered, including health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, weight management programs, and counseling.
Hearing Services See details
Hearing services are covered by Community Blue Medicare HMO Signature (HMO) with no coinsurance, requiring a $40 to $45 copay for hearing exams and a $699 to $999 copay for prescription hearing aids. This benefit is partially covered, as over-the-counter (OTC) hearing aids and inner ear, outer ear, or over the ear prescription hearing aids are not covered.
Vision Services See details
Community Blue Medicare HMO Signature (HMO) covers vision services, including one routine annual eye exam with a $25 copay and no coinsurance, though other eye exam services are not covered. Eyewear, including glasses and contacts, is covered with no copay or coinsurance up to a $100 annual maximum benefit.
Dental Services See details
Dental services are partially covered by Community Blue Medicare HMO Signature (HMO), which features a $1,500 annual maximum for non-Medicare dental care. Preventive services have no copay and no coinsurance, Medicare-covered dental has a $40 copay and no coinsurance, and covered comprehensive services require no copay and 50% coinsurance (0% to 50% coinsurance for adjunctive services). Other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Community Blue Medicare HMO Signature (HMO) with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs require between no coinsurance and 20% coinsurance, while Part B insulin is covered with a $35 copay and between no coinsurance and 20% coinsurance.
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
Community Blue Medicare HMO Signature (HMO) covers medical equipment with no copays, though prior authorization is required for most items. Durable medical equipment has a 0% to 50% coinsurance, prosthetics and medical supplies carry a 20% coinsurance, and diabetic equipment is only partially covered with no coinsurance, as diabetic supplies and 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, featuring no copay or coinsurance for lab services and a $0 to $10 copay with no coinsurance for diagnostic tests. Outpatient X-rays require a $45 copay, diagnostic radiological services start at a $250 copay, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Community Blue Medicare HMO Signature (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Community Blue Medicare HMO Signature (HMO) covers some cardiac rehabilitation services with no coinsurance, but cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Community Blue Medicare HMO Signature (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Other Services under the Community Blue Medicare HMO Signature (HMO) are partially covered, offering no copay and no coinsurance for over-the-counter (OTC) items and chronic illness meal benefits, while acupuncture is not covered. Eligible members receive up to a $75 allowance every three months for select OTC items and covered meals at no cost.
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