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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 2025, 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 North Central PA. This plan received an overall rating of 5 out of 5 stars in 2025.
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 $33.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6500.00 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 has an "Enhanced Alternative" drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you'll pay no copay for preferred generic drugs at a preferred pharmacy, and 25% coinsurance for standard generic drugs, 50% coinsurance for preferred brand drugs, and 33% coinsurance for non-preferred drugs. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays depending on the service. You'll have a $295 copay for inpatient hospital stays, and outpatient services have copays between $45 and $325. The plan also covers emergency services, ambulance services, and transportation to health-related locations. This plan provides coverage for primary care, including specialist visits, with copays ranging from $10 to $30. It also includes preventive services with no copay, and offers coverage for hearing exams, vision services, and dental services up to $3,000 per year. Additionally, the plan covers home infusion services, dialysis, medical equipment, and home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, there is a $295 copay per admission for a Medicare-covered stay and additional days are covered with no copay. For Inpatient Hospital Psychiatric, there is a $425 copay for days 1-3 and no copay for days 4-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services and Observation Services have a $325 copay. Ambulatory Surgical Center (ASC) Services have a $175 copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay between $45.00 and $45.00.
Partial Hospitalization See details
Partial Hospitalization is covered by the Community Blue Medicare HMO Signature (HMO) plan. There is no information provided about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Both ground and air ambulance services have a $275 copay, and transportation services to a plan-approved health-related location are covered with no copay or coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Community Blue Medicare HMO Signature (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, and Worldwide Emergency Transportation has a $275 copay; all services have no coinsurance.
Primary Care See details
Community Blue Medicare HMO Signature (HMO) covers primary care physician services, chiropractic services with a $10 copay, occupational therapy services with a $10 copay, specialist services, mental health specialty services with a $30 copay for individual and group sessions, podiatry services with a limit of 4 visits per year, other health care professional services, psychiatric services with a $30 copay for individual and group sessions, physical therapy and speech-language pathology services with no copay, additional telehealth benefits with a copay between $0 and $45, and opioid treatment program services with a $45 copay.
Preventive Services See details
The Community Blue Medicare HMO Signature (HMO) plan covers preventive services, including Medicare-covered services with no copay, and additional services like annual physical exams. Additional preventive services may have a coinsurance, and home and bathroom safety devices and modifications have a 20% coinsurance.
Hearing Services See details
The Community Blue Medicare HMO Signature (HMO) plan covers hearing exams and prescription hearing aids, with Routine Hearing Exams covered once per year. Fitting/Evaluation for Hearing Aids and Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and there is a copay between $699 and $999 for Prescription Hearing Aids (all types).
Vision Services See details
The Community Blue Medicare HMO Signature (HMO) plan covers vision services, including routine eye exams with one visit per year, and eyewear with a combined maximum of $400 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Community Blue Medicare HMO Signature (HMO) plan includes dental services, with a maximum benefit of $3,000 per year. Oral exams are covered once every six months, dental x-rays are covered once per year, and prophylaxis (cleaning), fluoride treatment, and restorative services are covered once every six months. Maxillofacial prosthetics, implant services, 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 coinsurance between 0-20%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Community Blue Medicare HMO Signature (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered under the Community Blue Medicare HMO Signature (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and medical supplies have a 20% coinsurance, and diabetic supplies have a 0-20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Community Blue Medicare HMO Signature (HMO) plan. Diagnostic Procedures/Tests and Lab Services are not covered, while Diagnostic Radiological Services have a copay of at most $200, Therapeutic Radiological Services have a copay of at most $60, and Outpatient X-Ray Services have a copay of $10.
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. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Community Blue Medicare HMO Signature (HMO) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Community Blue Medicare HMO Signature (HMO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items, with a maximum plan benefit coverage amount of $150.00 every three months. Acupuncture, Meal Benefit, 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, and Self-Directed Personal Assistance Services are not covered.
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