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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 $4.00. 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 a $0 copay for preferred generic drugs at a preferred pharmacy, and 25% coinsurance for standard generic drugs at preferred and standard pharmacies. For preferred brand drugs, you'll pay 50% coinsurance. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers a range of benefits, including inpatient hospital stays with a $250 copay, and outpatient services with copays ranging from $45 to $175. This plan also covers primary care, preventive services, and home health services with no copay, as well as vision and dental services, with a maximum dental benefit of $3000 per year. Additional benefits include hearing exams and hearing aids, ambulance services with a $250 copay, and diagnostic and radiological services with varying copays. The plan also covers home infusion, dialysis services with 20% coinsurance, medical equipment with 20% coinsurance, and skilled nursing facility stays with a copay after 20 days. However, some services, such as cardiac rehabilitation and additional hours of care, are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. Inpatient Hospital-Acute has a $250 copay per admission or stay for Medicare-covered stays, with no copay for additional days, and a $425 copay for days 1-3 of Inpatient Hospital Psychiatric stays and no copay for days 4-90. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services and Observation Services have a $175 copay, Ambulatory Surgical Center (ASC) Services have a $125 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a minimum and maximum copay of $45.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Community Blue Medicare HMO Signature (HMO) plan. Both ground and air ambulance services have a $250 copay, with no coinsurance. Transportation Services to a plan-approved health-related location are covered, but 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 by Community Blue Medicare HMO Signature (HMO). Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Worldwide Emergency Transportation has a $250 copay, and there is no coinsurance for any of these services.
Primary Care See details
The Community Blue Medicare HMO Signature (HMO) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy services with a $20 copay, physician specialist services, mental health specialty services with a $30 copay for individual and group sessions, podiatry services, other health care professional, psychiatric services with a $30 copay for individual and group sessions, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a copay between $0 and $45, and opioid treatment program services with a $45 copay. Routine chiropractic care is covered for up to 4 visits per year.
Preventive Services See details
The Community Blue Medicare HMO Signature (HMO) plan covers preventive services, including Medicare-covered services with no copay. Additional preventive services are covered, but some services, like Health Education and Counseling Services, are not covered. Home and Bathroom Safety Devices and Modifications have 20% coinsurance.
Hearing Services See details
The Community Blue Medicare HMO Signature (HMO) plan covers hearing exams and prescription hearing aids. Routine hearing exams are covered for one visit per year, and there is a copay between $699 and $999 for prescription hearing aids, with two visits per year. 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.
Vision Services See details
Vision services include coverage for routine eye exams, with one exam covered every year, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $400 per year. There is no deductible for these services.
Dental Services See details
The Community Blue Medicare HMO Signature (HMO) plan offers dental services with a maximum plan benefit of $3000 per year. This plan covers oral exams (1 every six months), dental x-rays (1 per year), prophylaxis (cleaning) (1 every six months), fluoride treatment (1 every six months), restorative services (1 every two years), adjunctive general services (2 per year), endodontics (root canal) (1, limited to one per tooth per lifetime), periodontics (limited to periodontal cleaning 1 every 6 months, scaling/root planing 1 every 36 months per area of mouth), prosthodontics, removable (limited to one set of dentures or partials every 5 years, relining and rebasing is eligible once in a 3 year period), prosthodontics, fixed (crowns, inlays, onlays and bridges are limited to one every 5 years), and oral and maxillofacial surgery (exposure of unerupted tooth limited to one tooth per lifetime). 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 between 0% and 20% coinsurance; other services have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Community Blue Medicare HMO Signature (HMO) plan. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical equipment is covered by Community Blue Medicare HMO Signature (HMO), with Durable Medical Equipment subject to 20% coinsurance and Prosthetic Devices and Medical Supplies subject to 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts are subject to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Community Blue Medicare HMO Signature (HMO) plan. Diagnostic Procedures/Tests and Lab Services are not covered, while Diagnostic Radiological Services have a maximum copay of $200, Therapeutic Radiological Services have a maximum copay of $60, and Outpatient X-Ray Services have a $10 copay.
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 under the Community Blue Medicare HMO Signature (HMO) plan. Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are all not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Community Blue Medicare HMO Signature (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items with a maximum plan benefit of $125 every three months. However, acupuncture, meal benefits, 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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