A non-government entity
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:
Sign up for Community Blue Medicare HMO Signature (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Community Blue Medicare HMO Signature (HMO) plan features an annual drug deductible of $615. For prescription drugs, Tier 1 preferred generics have no copay when filled at a preferred pharmacy or through preferred mail order. Tier 2 generic medications cost as little as a $3 copay for a one-month supply at preferred pharmacies, though standard pharmacies and standard mail order options will carry higher copays. Brand-name and specialty drugs under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty tier medications require a 25% coinsurance across all pharmacy and mail order types.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers affordable healthcare coverage, featuring no copay for primary care doctor visits and a $55 copay for specialists. If you require hospital services, inpatient stays have a $400 daily copay for days one through six and no copay for subsequent days, while emergency room visits carry a $130 copay. Outpatient hospital services require a $450 copay, and urgently needed care is available for a $40 copay. For additional wellness benefits, preventive care and home health services are covered with no copay. Dental benefits include preventive care with no copay up to a $1,000 annual maximum, and vision benefits offer a $100 annual allowance for eyewear with no copay. Members also receive a $75 quarterly over-the-counter allowance and skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital care is covered under Community Blue Medicare HMO Signature (HMO) with no coinsurance and requires prior authorization, but is only partially covered because acute room upgrades, psychiatric additional days, and psychiatric non-Medicare-covered stays are not covered. Acute stays require a $400 daily copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays require a $405 daily copay for days 1 to 4 and no copay for days 5 to 90.
Outpatient Services See details
Community Blue Medicare HMO Signature (HMO) covers outpatient services with no coinsurance, requiring a $450 copay for outpatient hospital and daily observation services, and a $350 copay for ambulatory surgical center services. Outpatient substance abuse sessions have a $40 copay with no coinsurance, and outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered by Community Blue Medicare HMO Signature (HMO) with a copayment of $55.00 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. Transportation services to 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, which is waived if you are admitted to the hospital within one day, and no coinsurance. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $40, and $390 respectively.
Primary Care See details
Community Blue Medicare HMO Signature (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $55 copay and no coinsurance. Additional services like physical therapy, mental health, and telehealth feature copays ranging from $0 to $55 with no coinsurance, though chiropractic care is only partially covered because other chiropractic services are not covered.
Preventive Services See details
Preventive Services are covered with no copay and no coinsurance under the Community Blue Medicare HMO Signature (HMO) plan, including annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive services are partially covered, but health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered under the Community Blue Medicare HMO Signature (HMO) plan, featuring no deductibles and no coinsurance. Covered benefits include one annual routine hearing exam for a $45 copay, unlimited fitting evaluations for a $55 copay, and up to two prescription hearing aids per year with a $699 to $999 copay, while OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Community Blue Medicare HMO Signature (HMO), offering eye exams with no coinsurance and copays ranging from $0 to $55, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing a $100 annual maximum benefit for contacts, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered by Community Blue Medicare HMO Signature (HMO) up to a $1,000 annual maximum, though other diagnostic, other preventive, maxillofacial prosthetics, implant services, and orthodontics are not covered. Preventive services require no copay and no coinsurance, Medicare-covered dental has a $55 copay and no coinsurance, and covered comprehensive services have no copay and 50% coinsurance (0% to 50% for adjunctive services).
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Community Blue Medicare HMO Signature (HMO) plan with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require between no coinsurance and 20% coinsurance, while Medicare Part B insulin has 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 durable medical equipment with no copay and 0% to 50% coinsurance, and prosthetics with no copay and 20% coinsurance, both requiring prior authorization. Diabetic equipment is partially covered with no copay or coinsurance, but 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, requiring prior authorization for these benefits. Lab services have no copay or coinsurance, diagnostic tests require a $0 to $10 copay with no coinsurance, outpatient X-rays carry a $45 copay, diagnostic radiology has a minimum $300 copay, and therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Community Blue Medicare HMO Signature (HMO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Community Blue Medicare HMO Signature (HMO) with no coinsurance, but only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and carry 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, though prior authorization is required and additional days beyond the standard 100-day benefit period are not covered. There is no copay for days 1 through 20 and a $218 copay for days 21 through 100, with no prior three-day inpatient hospital stay required for admission.
Other Services See details
Community Blue Medicare HMO Signature (HMO) partially covers other services, providing a meal benefit for chronic illnesses and a $75 quarterly over-the-counter (OTC) allowance with no copay and no coinsurance. Acupuncture, nicotine replacement therapy, naloxone, and some CMS OTC list drugs are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved