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Security Blue HMO-POS ValueRx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Security Blue HMO-POS ValueRx (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Security Blue HMO-POS ValueRx (HMO-POS) in 2026, please refer to our full plan details page.
Security Blue HMO-POS ValueRx (HMO-POS) is a HMO-POS plan offered by Highmark Health available for enrollment in 2025 to people living in Southwestern PA. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Security Blue HMO-POS ValueRx (HMO-POS) 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 Security Blue HMO-POS ValueRx (HMO-POS).
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 Security Blue HMO-POS ValueRx (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8950.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8950.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Security Blue HMO-POS ValueRx (HMO-POS) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at a preferred pharmacy, as well as no copay for a 3-month supply through preferred mail order. Tier 2 generic drugs are also highly affordable, with a 1-month copay of $13 at preferred pharmacies and $19 at standard pharmacies. Tier 3 preferred brand drugs require a $45 copay for a 1-month supply at preferred pharmacies and a $47 copay at standard pharmacies. For higher-tier medications, costs transition to coinsurance, with Tier 4 non-preferred drugs requiring 35% coinsurance for all supply options. Tier 5 specialty drugs carry a 33% coinsurance for a 1-month supply at both standard and preferred pharmacies or mail-order services.
Additional Benefits
The Security Blue HMO-POS ValueRx (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits, annual physicals, and home health services. Specialized care is highly affordable, featuring a $35 copay for specialists and no coinsurance for inpatient hospital stays, which require a $220 daily copay for the first five days. Outpatient hospital services and emergency care are also covered with fixed copays of $200 and $130, respectively, and no coinsurance. This plan also features valuable everyday benefits, including preventive dental care and a $425 annual eyewear allowance with no copay or coinsurance. Routine vision and hearing exams are accessible with a $35 copay, while up to two prescription hearing aids are covered annually with copays between $599 and $899. For added convenience, members can utilize up to 24 one-way transportation trips per year to plan-approved locations with no copay.
Inpatient Hospital See details
Security Blue HMO-POS ValueRx (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $220 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Security Blue HMO-POS ValueRx (HMO-POS) covers outpatient hospital and daily observation services with a $200 copay and no coinsurance, and ambulatory surgical center services with a $175 copay and no coinsurance. Outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Security Blue HMO-POS ValueRx (HMO-POS) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Security Blue HMO-POS ValueRx (HMO-POS) covers ground and air ambulance services with a $280 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Security Blue HMO-POS ValueRx (HMO-POS) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 3 days, and urgently needed services with a $50 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $50 to $280.
Primary Care See details
Security Blue HMO-POS ValueRx (HMO-POS) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Other covered benefits, such as physical therapy, psychiatric services, and occupational therapy, carry a $40 copay and no coinsurance, while chiropractic care is partially covered with a $15 copay and no coinsurance for routine care only.
Preventive Services See details
Security Blue HMO-POS ValueRx (HMO-POS) offers partially covered preventive services, providing annual physicals, kidney education, and select screenings with no copay and no coinsurance. Remote access technologies have a $0 to $35 copay, and home safety devices require a 20% coinsurance. However, sub-services like health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, and counseling are not covered.
Hearing Services See details
Security Blue HMO-POS ValueRx (HMO-POS) partially covers hearing services, offering one routine hearing exam per year for a $35 copay and no coinsurance. Up to two prescription hearing aids are covered annually with a copay ranging from $599 to $899 and no coinsurance, though fitting and evaluations, OTC hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Security Blue HMO-POS ValueRx (HMO-POS) partially covers vision services with no deductibles, featuring a $35 copay and no coinsurance for one routine eye exam per year, while other eye exams are not covered. Eyewear, including contacts, eyeglasses, and upgrades, is covered with no copay and no coinsurance up to a $425 combined annual maximum.
Dental Services See details
Security Blue HMO-POS ValueRx (HMO-POS) partially covers dental services, offering Medicare-covered dental for a $35 copay and no coinsurance, and other covered dental services for a $15 copay and no coinsurance. Covered preventive care includes exams, cleanings, and x-rays with no coinsurance, alongside adjunctive general services with no copay and no coinsurance. Restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, orthodontics, fluoride, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Security Blue HMO-POS ValueRx (HMO-POS) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and 0% to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Security Blue HMO-POS ValueRx (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Security Blue HMO-POS ValueRx (HMO-POS) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copay and a required prior authorization. Most covered equipment and supplies carry a 20% coinsurance, while diabetic supplies range from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
Security Blue HMO-POS ValueRx (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization is required for these services. Members will pay no copay for lab services, a $20 copay for outpatient x-rays, between $0 and $20 for diagnostic tests, and minimum copays of $175 for diagnostic radiological services and $60 for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the Security Blue HMO-POS ValueRx (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Security Blue HMO-POS ValueRx (HMO-POS) plan because none of the sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered.
Skilled Nursing Facility (SNF) See details
Security Blue HMO-POS ValueRx (HMO-POS) partially covers Skilled Nursing Facility (SNF) care with no coinsurance, as additional days beyond the Medicare-covered limit are not covered. Covered stays require prior authorization and feature no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, without requiring a prior three-day hospital stay.
Other Services See details
Security Blue HMO-POS ValueRx (HMO-POS) partially covers other services, offering a limited-duration meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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