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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 $5.00. 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 15 dollars for standard generic drugs at a standard pharmacy. You will pay coinsurance for other drug tiers, including 25% for standard generic drugs, 50% for preferred brand drugs, and 33% for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers a range of benefits with varying cost-sharing. This plan covers inpatient hospital stays with a copay, outpatient services with copays, and emergency services with a copay. You will also have access to primary care, preventive, vision, and dental services, with different cost-sharing amounts for each. The plan also provides coverage for hearing exams and hearing aids with a copay, and medical equipment with coinsurance. Other covered services include home health, skilled nursing facility, diagnostic and radiological services, and dialysis services. Please review the sub-summaries for details on copays, coinsurance, and any limitations on the services.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $250 copay per admission for a Medicare-covered stay, and additional days have no copay; Non-Medicare-covered stays and upgrades are not covered. Inpatient Hospital Psychiatric has a $425 copay for days 1-3, and no copay for days 4-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $175 copay, while ambulatory surgical center services have a $125 copay. Individual and group sessions for outpatient substance abuse have a 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, including ground and air ambulance services, as well as transportation to plan-approved health-related locations. Ground and air ambulance services have a $250 copay, and 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. Emergency Services and Worldwide Emergency Coverage have a $125 copay and no coinsurance, while Worldwide Emergency Transportation has a $250 copay and no coinsurance.
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 or group sessions, podiatry services, other health care professional services, psychiatric services with a $30 copay for individual or 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 limited to 4 visits per year.
Preventive Services See details
The Community Blue Medicare HMO Signature (HMO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, and other services, with no copay. Additional preventive services are covered, and some services have a 20% coinsurance. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Telemonitoring Services are not covered.
Hearing Services See details
The Community Blue Medicare HMO Signature (HMO) plan covers hearing exams, including routine hearing exams, with 1 exam covered per year, but does not cover fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $699 and $999 for prescription hearing aids (all types), but the plan does not cover inner ear, outer ear, or over the ear hearing aids, as well as OTC hearing aids.
Vision Services See details
Vision services include coverage for routine eye exams once per year, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum plan benefit coverage of $400 per year.
Dental Services See details
The Community Blue Medicare HMO Signature (HMO) plan covers various dental services, including oral exams, dental x-rays, cleanings, and fluoride treatments, with a maximum annual benefit of $3,000. Endodontics, periodontics, prosthodontics (removable and fixed), and oral surgery are covered, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment is covered by Community Blue Medicare HMO Signature (HMO), including durable medical equipment, prosthetics/medical supplies, and diabetic equipment. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic supplies have a 0-20% coinsurance, and therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic procedures/tests and lab services are not covered. 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 or 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 by the Community Blue Medicare HMO Signature (HMO) plan, but require prior authorization. For days 1-20, there is no copay, but for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $120.00 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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