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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 2025, 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 5 out of 5 stars in 2025.
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 $30.00. 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) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, the copay is $13 at a preferred pharmacy and $19 at a standard pharmacy. For standard generic drugs, the copay is $45 at a preferred pharmacy and $47 at a standard pharmacy. Preferred brand drugs have a $95 copay at a preferred pharmacy and a $100 copay at a standard pharmacy. Non-preferred drugs have a 33% coinsurance.
Additional Benefits
The Security Blue HMO-POS ValueRx (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $220 copay for the first five days, and no copay for the remainder of the stay. The plan covers outpatient services, primary care, preventive services, hearing, vision, dental, and home health services, with specific copays for each service. This plan also includes coverage for emergency services, ambulance, and transportation, and other services such as home infusion, dialysis, medical equipment, and diagnostic services. The plan offers a meal benefit for chronic illness. However, some services like acupuncture, over-the-counter items, and certain dental and rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $220 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you pay a $220 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $200 copay, while ambulatory surgical center services have a $175 copay. Individual and group sessions for outpatient substance abuse have a copay between $40 and $40.
Partial Hospitalization See details
Partial Hospitalization benefits are covered under the Security Blue HMO-POS ValueRx (HMO-POS) plan. The plan covers all services related to partial hospitalization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Security Blue HMO-POS ValueRx (HMO-POS) plan. Ground and air ambulance services have a $245 copay, while transportation services to any health-related location are limited to 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Security Blue HMO-POS ValueRx (HMO-POS) plan. Emergency Services have a $125 copay with no coinsurance, Urgently Needed Services have a $5 copay with no coinsurance, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $5 copay, and Worldwide Emergency Transportation has a $245 copay, with no coinsurance for any of the services.
Primary Care See details
The Security Blue HMO-POS ValueRx (HMO-POS) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $40 copay, and physician specialist services with a $35 copay. The plan also covers mental health specialty services with a $40 copay for individual and group sessions, podiatry services with a $35 copay, and other health care professional services with a copay ranging from $0 to $35. Additionally, psychiatric services have a $40 copay for both individual and group sessions, physical therapy and speech-language pathology services have a $40 copay, and opioid treatment program services have a $40 copay. The plan also covers additional telehealth benefits with a copay ranging from $0 to $40.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams, and additional preventive services, along with Fitness Benefit and Enhanced Disease Management with no copay or coinsurance. Remote Access Technologies have a copay between $0 and $35, while Home and Bathroom Safety Devices and Modifications have 20% coinsurance. Other services like Health Education, Counseling Services, and others are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $35 copay, and prescription hearing aids with a copay between $599 and $899; fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered. You are limited to 1 routine hearing exam per year, and 2 prescription hearing aids per year.
Vision Services See details
Vision services include coverage for eye exams with a $35 copay, and also cover routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $425 every year.
Dental Services See details
Dental Services include Medicare Dental Services with a $35 copay, and Other Dental Services with a $15 copay. Oral exams, dental x-rays, and teeth cleanings are covered, but fluoride treatment is not. Orthodontic services, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For other drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Security Blue HMO-POS ValueRx (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment. Diabetic Supplies have no copay and between 0% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have between 20% and 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Security Blue HMO-POS ValueRx (HMO-POS) plan. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $20, Lab Services have no copay, Diagnostic Radiological Services have a copay of at least $175, Therapeutic Radiological Services have a copay of at least $60, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Security Blue HMO-POS ValueRx (HMO-POS) plan with no copay or coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Security Blue HMO-POS ValueRx (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, but there is a $214 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Security Blue HMO-POS ValueRx (HMO-POS) plan does not cover acupuncture, over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services. The plan covers a Meal Benefit for a chronic illness, with no maximum coverage amount.
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