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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:
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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 generic and Tier 2 generic drugs, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies and through preferred mail order. If you choose standard pharmacies or standard mail order, Tier 1 drugs require a $7 copay for a 1-month supply ($21 for 3 months) and Tier 2 drugs require a $15 copay for a 1-month supply ($45 for 3 months). Higher-tier medications are subject to coinsurance rather than flat copays. Tier 3 preferred brands require a 20% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance, regardless of whether you use preferred or standard services.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers affordable coverage for core medical needs, featuring no copay and no coinsurance for primary care physician visits. Specialist visits, physical therapy, and routine dental, vision, and hearing exams require a low $20 copay with no coinsurance. For more intensive care, inpatient hospital admissions require a $325 copay, while emergency room visits incur a $130 copay, with no coinsurance required for either service. This plan also provides generous allowances for supplemental health benefits, including up to $3,000 annually for covered dental services and a $400 yearly eyewear limit with no copay. Members enjoy no copay for home health services, unlimited transportation to approved medical locations, and a $40 quarterly allowance for over-the-counter items. Additionally, diagnostic lab services and the first 20 days of a skilled nursing facility stay are fully covered with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Community Blue Medicare HMO Signature (HMO), requiring prior authorization and featuring no coinsurance. Acute stays incur a $325 copay per admission with no copay for unlimited additional days, whereas psychiatric stays require a $425 daily copay for days 1 through 3 and no copay for days 4 through 90. 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. Additionally, outpatient substance abuse services require a $45 copay per individual or group session, while outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Community Blue Medicare HMO Signature (HMO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Community Blue Medicare HMO Signature (HMO), featuring a $175 copay and no coinsurance for ground and air ambulance services. Transportation is partially covered, offering unlimited one-way trips to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Community Blue Medicare HMO Signature (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services have a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $40, and $175 respectively.
Primary Care See details
Community Blue Medicare HMO Signature (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and speech therapy require a $20 copay and no coinsurance. Chiropractic services are partially covered, with routine care requiring a $10 copay and no coinsurance for up to 4 visits per year, while other chiropractic services are not covered. Other covered benefits, including mental health, psychiatric, podiatry, and telehealth, feature copays ranging from $0 to $45 and no coinsurance.
Preventive Services See details
Community Blue Medicare HMO Signature (HMO) preventive services are partially covered, offering annual physical exams, kidney disease education, and other screenings with no copay and no coinsurance. Remote access technologies require a $0 to $20 copay with no coinsurance, and home safety devices require a 20% coinsurance with no copay, while services like health education, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Hearing Services are partially covered by Community Blue Medicare HMO Signature (HMO), featuring a $20 copay and no coinsurance for one routine hearing exam per year. Prescription hearing aids are covered with no coinsurance and a copay between $699 and $999, but fitting and evaluations, OTC hearing aids, and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Community Blue Medicare HMO Signature (HMO) partially covers vision services with no deductibles, offering one routine eye exam per year for a $20 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, including contacts and eyeglasses, features no copay and no coinsurance up to a $400 annual limit.
Dental Services See details
Dental services are partially covered by Community Blue Medicare HMO Signature (HMO), featuring a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered dental services up to a $3,000 annual maximum. Services not covered under this plan include other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Community Blue Medicare HMO Signature (HMO) with no copay, subject to prior authorization. Under this benefit, covered Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin drugs require 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 copays, though prior authorization is required. Durable medical equipment features no coinsurance to 50% coinsurance, diabetic supplies range from no coinsurance to 20% coinsurance, and prosthetics, medical supplies, and diabetic shoes carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Community Blue Medicare HMO Signature (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Under this plan, lab services have no copay, outpatient X-rays cost $10, diagnostic procedures and tests range from a $0 to $10 copay, and diagnostic and therapeutic radiological services require minimum copays of $150 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
Cardiac Rehabilitation Services are not covered by the Community Blue Medicare HMO Signature (HMO) plan, which does not provide coverage for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Community Blue Medicare HMO Signature (HMO) covers skilled nursing facility (SNF) stays with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Community Blue Medicare HMO Signature (HMO) partially covers other services, offering an over-the-counter (OTC) benefit of up to $40 every three months with no copay and no coinsurance. Acupuncture and meal benefits are not covered.
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