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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 $22.00. 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:
Sign up for Community Blue Medicare HMO Signature (HMO)
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Drug Coverage
The Community Blue Medicare HMO Signature (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay for 1-month and 3-month supplies at preferred pharmacies and through preferred mail order. Standard pharmacies and standard mail order options require a copay of $7 to $21 for Tier 1, and $15 to $45 for Tier 2. Brand-name and specialty medications are covered under coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance across all pharmacy and mail order channels.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers comprehensive medical coverage featuring no copay for primary care visits, home health services, and annual physicals. Specialist visits, physical therapy, and routine eye or hearing exams are available with a $20 copay and no coinsurance. For urgent and emergency needs, members pay a $40 copay for urgent care and a $130 copay for emergency room visits with no coinsurance. Inpatient hospital stays require a $325 copay per stay with no coinsurance, while skilled nursing facility care features no copay for the first 20 days. The plan also includes strong supplemental coverage, providing up to a $3,000 annual limit for dental care and a $400 allowance for eyewear with no copay or coinsurance. Additionally, diagnostic lab services and home infusion therapy are covered with no copay, helping to keep your healthcare costs predictable.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Community Blue Medicare HMO Signature (HMO) with no coinsurance, though prior authorization is required. Acute stays require a $325 copay per stay with unlimited additional days at no copay, while psychiatric stays have a $425 copay per day for days 1 through 3 and no copay for days 4 through 90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Community Blue Medicare HMO Signature (HMO) covers outpatient services with no coinsurance, featuring a $200 copay for outpatient hospital and daily observation services, and a $150 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $45 copay with no coinsurance, while outpatient blood services are fully covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the Community Blue Medicare HMO Signature (HMO) plan. Members will pay no copay and no coinsurance for these covered services.
Ambulance and Transportation Services See details
Community Blue Medicare HMO Signature (HMO) covers ground and air ambulance services with a $175 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, offering unlimited one-way trips to plan-approved health-related locations with no copay and no coinsurance, though transportation to any other 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 urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $40, and $175, respectively, and these costs do not count toward the plan deductible.
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. Chiropractic services are partially covered with a $10 copay and no coinsurance for up to four routine visits per year, as other chiropractic services are not covered. Other covered benefits like mental health, psychiatric, podiatry, and telehealth services feature copays ranging from $0 to $45 and no coinsurance.
Preventive Services See details
Preventive Services under the Community Blue Medicare HMO Signature (HMO) are partially covered, featuring annual physicals, kidney disease education, and select screenings with no copay and no coinsurance. While memory fitness, remote access technologies ($0 to $20 copay, no coinsurance), and home safety devices (20% coinsurance, no copay) are covered, several services—including health education, personal emergency response systems, and nutritional counseling—are not covered.
Hearing Services See details
Community Blue Medicare HMO Signature (HMO) partially covers hearing services, offering one routine hearing exam per year with 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 evaluation services, OTC hearing aids, and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Community Blue Medicare HMO Signature (HMO) features partially covered vision services, which include one routine eye exam per year for a $20 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, offering up to a $400 annual maximum benefit for contact lenses, eyeglasses, and upgrades.
Dental Services See details
Community Blue Medicare HMO Signature (HMO) offers partially covered dental services, 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. Sub-services that are not covered under this plan include other diagnostic services, other preventive services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Community Blue Medicare HMO Signature (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Covered Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Community Blue Medicare HMO Signature (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Community Blue Medicare HMO Signature (HMO) with no copay, 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 therapeutic shoes.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Community Blue Medicare HMO Signature (HMO) with no coinsurance and prior authorization required. Lab services have no copay, diagnostic tests range from a $0 to $10 copay, outpatient X-rays cost $10, and therapeutic and diagnostic radiological services have copays starting at $60 and $150 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) offers some covered services for Cardiac Rehabilitation Services with no copay and no coinsurance. However, specific sub-services including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, 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, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 through 20, and a $218 copay applies for days 21 through 100, with no prior three-day inpatient hospital stay required.
Other Services See details
Community Blue Medicare HMO Signature (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $40 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone coverage are not covered under this benefit.
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