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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. This plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have a 25% coinsurance.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a $250 copay per admission, outpatient services with varying copays, and emergency services with a $125 copay. Primary care, preventive services, vision, and dental services are also covered, with specific copays and annual maximums. This plan provides additional benefits such as hearing services, home health services with no copay, and medical equipment with coinsurance. However, it's important to note that certain services like cardiac rehabilitation and some specialized dental procedures are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $250 copay per admission or stay for Medicare-covered stays, with additional days covered with no copay. Inpatient Hospital Psychiatric services have a $425 copay for days 1-3, and no copay for days 4-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a $175 copay, Ambulatory Surgical Center (ASC) Services with a $125 copay, and Outpatient Substance Abuse Services with a $45 copay for both individual and group sessions, as well as Outpatient Blood Services. This plan waives the three (3) pint deductible for Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the Community Blue Medicare HMO Signature (HMO) plan. There is no further cost information available for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Community Blue Medicare HMO Signature (HMO) plan, but prior authorization is required. Ground and air ambulance services have a $250 copay, and transportation services to a plan-approved health-related location are covered. 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 the Community Blue Medicare HMO Signature (HMO) plan. 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, chiropractic services with a $10 copay, occupational therapy services with a $20 copay, specialist services, mental health specialty services with a $30 copay, podiatry services, other healthcare professional services, psychiatric services with a $30 copay, physical therapy and speech-language pathology services with a $20 copay, telehealth benefits with a $0 - $45 copay, and opioid treatment program services with a $45 copay. Routine Chiropractic Care has a $10 copay for up to 4 visits per year.
Preventive Services See details
The Community Blue Medicare HMO Signature (HMO) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services such as Home and Bathroom Safety Devices and Modifications have 20% coinsurance.
Hearing Services See details
Hearing services include routine hearing exams, covered once per year, and prescription hearing aids, with a copay between $699 and $999, covered twice per year. Fitting/evaluation for hearing aids, prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
The Community Blue Medicare HMO Signature (HMO) plan covers vision services, including routine eye exams once per year, and eyewear with a combined maximum benefit of $400 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. There is no deductible for these services.
Dental Services See details
Community Blue Medicare HMO Signature (HMO) offers dental services, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment, with a maximum benefit of $3,000 per year; however, maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services are covered under diagnostic and preventive dental, with a maximum benefit.
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, you will pay a $35 copay and between 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Community Blue Medicare HMO Signature (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Community Blue Medicare HMO Signature (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but 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 $10 copay.
Home Health Services See details
Home Health Services are covered by Community Blue Medicare HMO Signature (HMO) with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Community Blue Medicare HMO Signature (HMO) plan. Specifically, 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 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
The Community Blue Medicare HMO Signature (HMO) plan does not cover acupuncture, meal benefits, or Dual Eligible SNPs with Highly Integrated Services. Over-the-Counter (OTC) Items are covered, with a maximum plan benefit of $140 every three months. All additional services are not covered.
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