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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 2025 to people living in Central and Northeastern, PA. This plan received an overall rating of 4.5 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 $26.00. 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. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options charge a copay of $7 for Tier 1 and $15 for Tier 2 medications for a 1-month supply. For brand-name and specialty medications, costs transition to a percentage-based coinsurance. You will pay a 20% coinsurance for Tier 3 preferred brand drugs, and a 25% coinsurance for Tier 4 non-preferred drugs and Tier 5 specialty drugs across all pharmacy and mail-order networks.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers cost-effective healthcare coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. Specialist visits and therapy services require a budget-friendly $20 copay, while emergency room visits carry a $130 copay. For hospital care, inpatient stays feature a $325 copay per admission and outpatient services carry a $250 copay, both with no coinsurance. Supplemental benefits include dental coverage with no copay up to a $3,000 annual limit and routine vision care with a $400 eyewear allowance. Diagnostic lab tests, home infusion services, and initial skilled nursing facility stays are also covered with no copay. Durable medical equipment and dialysis services are available with no copays, though they carry coinsurance ranging up to 50%.
Inpatient Hospital See details
Community Blue Medicare HMO Signature (HMO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for stays. Acute care requires a $325 copay per admission with no copay for unlimited additional days, while psychiatric stays require a $425 daily copay for days 1 to 3 and no copay for days 4 to 90, though upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Community Blue Medicare HMO Signature (HMO) with no coinsurance, featuring a $250 copay for outpatient hospital and daily observation services, and a $200 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $45 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 no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Community Blue Medicare HMO Signature (HMO), requiring a $275 copay and no coinsurance for ground and air ambulance services. Transportation is partially covered, offering unlimited one-way trips to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Community Blue Medicare HMO Signature (HMO) covers emergency services with a $130 copay (waived if admitted within 3 days) and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $40, and $275, 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, physical therapy, and occupational therapy require a $20 copay and no coinsurance. Additional services like mental health care and routine chiropractic care (limited to 4 visits per year; other chiropractic services are not covered) feature copays ranging from $10 to $45 and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by Community Blue Medicare HMO Signature (HMO), offering annual physicals, kidney disease education, routine screenings, memory fitness, and enhanced disease management with no copay and no coinsurance. Remote access technologies require a $0 to $20 copay (no coinsurance) and home safety devices require a 20% coinsurance (no copay), while health education, PERS, in-home safety assessments, 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, additional smoking cessation, telemonitoring, and counseling are not covered.
Hearing Services See details
Community Blue Medicare HMO Signature (HMO) partially covers hearing services, offering one routine hearing exam annually for a $20 copay and no coinsurance, and up to two prescription hearing aids per year with a $699 to $999 copay and no coinsurance. 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
Vision services are partially covered by Community Blue Medicare HMO Signature (HMO), which excludes other eye exam services but covers one annual routine exam with a $20 copay and no coinsurance. Eyewear is covered with no copay or coinsurance up to a $400 annual maximum, with no deductibles required for any covered services.
Dental Services See details
Dental Services are partially covered by Community Blue Medicare HMO Signature (HMO), requiring a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $3,000 annual limit. While routine exams, cleanings, x-rays, and restorative care are covered at no cost, orthodontic, implant, maxillofacial prosthetic, and select diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Community Blue Medicare HMO Signature (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, insulin, and other drugs are covered with coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
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. Durable medical equipment incurs no coinsurance to 50% coinsurance, diabetic supplies carry no coinsurance to 20% coinsurance from specified manufacturers, and prosthetics, medical supplies, and diabetic shoes require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Community Blue Medicare HMO Signature (HMO) with no coinsurance, though prior authorization is required. Lab services have no copay, outpatient X-rays require a $10 copay, and diagnostic procedures carry a $0 to $10 copay, while diagnostic and therapeutic radiological services have minimum copays of $200 and $60 respectively.
Home Health Services See details
Home health services are covered by Community Blue Medicare HMO Signature (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Community Blue Medicare HMO Signature (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Community Blue Medicare HMO Signature (HMO) covers Skilled Nursing Facility (SNF) services 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 copay per day for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Community Blue Medicare HMO Signature (HMO) provides partial coverage for Other Services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $40 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this benefit.
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