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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 $16.00. 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 prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you can benefit from no copay for 1-month and 3-month supplies when using preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order options require a copay of $7 for Tier 1 and $15 for Tier 2 for a 1-month supply. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. These coinsurance percentages apply across both preferred and standard pharmacies as well as mail-order delivery.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers robust coverage with no copay and no coinsurance for primary care visits, preventive screenings, and home health services. Specialist visits require a $20 copay, while acute inpatient hospital stays require a $325 copay per stay with no coinsurance. Emergency room visits carry a $130 copay, and outpatient hospital services require a $250 copay. For supplemental care, members enjoy dental benefits with no copay up to a $3,000 annual limit, alongside a $400 annual allowance for eyewear with no copay. Routine vision and hearing exams are accessible with a $20 copay, and the plan covers up to two prescription hearing aids per year with copays ranging from $699.00 to $999.00. Additionally, skilled nursing facility stays feature no copay for the first 20 days, and members receive a $40 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Community Blue Medicare HMO Signature (HMO) covers inpatient hospital services with no coinsurance, requiring prior authorization and a $325 copay per stay for acute care, while psychiatric care requires a $425 daily copay for days 1 through 3 and no copay for days 4 through 90. This benefit is partially covered because upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Community Blue Medicare HMO Signature (HMO) covers outpatient hospital and daily observation services with a $250 copay and no coinsurance, and ambulatory surgical center services with a $200 copay and no coinsurance. Outpatient substance abuse individual and group sessions require a $45 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Community Blue Medicare HMO Signature (HMO) covers partial hospitalization services with no copay and no coinsurance. This benefit ensures you pay nothing for these covered services under the plan.
Ambulance and Transportation Services See details
Community Blue Medicare HMO Signature (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance. Transportation services to plan-approved locations are partially covered with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Community Blue Medicare HMO Signature (HMO) with a $130 copay and no coinsurance, with the copay waived if admitted to the hospital within 3 days. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $40, and $250 respectively.
Primary Care See details
Community Blue Medicare HMO Signature (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $20 copay and no coinsurance. Chiropractic services are partially covered, offering routine care for a $10 copay and no coinsurance while excluding other chiropractic services, and other benefits like mental health, therapy, and podiatry are covered with copays up to $45 and no coinsurance.
Preventive Services See details
Community Blue Medicare HMO Signature (HMO) covers preventive services, offering annual physicals, kidney disease education, and routine screenings with no copay and no coinsurance. Additional benefits are partially covered, offering memory fitness, remote access technologies (with a $0 to $20 copay), and safety devices (with 20% coinsurance), while 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, smoking cessation, telemonitoring, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered under the Community Blue Medicare HMO Signature (HMO) plan, which offers one routine hearing exam per year for a $20 copay and no coinsurance, with no deductible. Up to two prescription hearing aids per year are covered with a copay ranging from $699.00 to $999.00 and no coinsurance, but fitting or evaluation services, over-the-counter (OTC) hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Community Blue Medicare HMO Signature (HMO) partially covers vision services, offering one routine annual eye exam with a $20 copay and no coinsurance, while other eye exam services are not covered. Eyewear, including contact lenses, eyeglasses, and upgrades, is covered with no copay and no coinsurance up to a $400 annual maximum.
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. Covered services include exams, cleanings, x-rays, fluoride, and various restorative and surgical procedures, while other diagnostic and preventive services, maxillofacial prosthetics, implants, and orthodontics 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. Covered Medicare Part B drugs, including chemotherapy and radiation, have no coinsurance to 20% coinsurance, while covered Part B insulin drugs require a $35 copay and no coinsurance to 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 medical equipment with no copays, though prior authorization is required. Coinsurance ranges from no coinsurance to 50% for durable medical equipment, is 20% for prosthetics and medical supplies, and ranges from no coinsurance to 20% for diabetic supplies and services.
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, diagnostic procedures range from a $0 to $10 copay, outpatient X-rays cost $10, and diagnostic and therapeutic radiological services require minimum copays of $200 and $60, respectively.
Home Health Services See details
Community Blue Medicare HMO Signature (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Community Blue Medicare HMO Signature (HMO) provides coverage for some services under Cardiac Rehabilitation Services with no copay and no coinsurance, 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 Community Blue Medicare HMO Signature (HMO) with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Community Blue Medicare HMO Signature (HMO), which provides over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $40 every three months. Acupuncture and meal benefits are not covered.
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