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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 $17.00. 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 $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 features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail order, Tier 1 drugs carry a $7 copay for a 1-month supply ($21 for 3 months), while Tier 2 drugs require a $15 copay for a 1-month supply ($45 for 3 months). For higher-tier medications under this plan, cost-sharing transitions to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance regardless of whether you use a preferred or standard pharmacy.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers affordable healthcare coverage with no copays or coinsurance for primary care visits, specialist consultations, routine preventive services, and home health care. Routine dental, vision, and hearing exams are also available with no copays, featuring up to a $3,000 annual dental maximum and a $400 yearly eyewear allowance. For urgent and emergency needs, members face a $40 urgent care copay and a $130 emergency room copay, which is waived upon hospital admission. Inpatient acute hospital stays require a $250 copay per stay with no coinsurance, while outpatient hospital visits require a $175 copay. Skilled nursing facility care is highly affordable, featuring no copay for the first 20 days of your stay. Additionally, the plan includes no-copay unlimited transportation to approved medical sites and a $40 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services are covered by Community Blue Medicare HMO Signature (HMO) with no coinsurance, featuring a $250 copay per stay for acute care and a $425 daily copay for days 1 through 3 (no copay for days 4 through 90) for psychiatric stays. Prior authorization is required, and non-Medicare-covered stays or upgrades are not covered.
Outpatient Services See details
Community Blue Medicare HMO Signature (HMO) covers outpatient services with no coinsurance, featuring a $175 copay for outpatient hospital and daily observation services, and a $125 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $45 copay with no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Community Blue Medicare HMO Signature (HMO) 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), with ground and air ambulance services requiring a $215 copay and no coinsurance. Transportation services are partially covered, offering unlimited one-way rides 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, which is waived if admitted to the hospital within three 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 $215, respectively.
Primary Care See details
Community Blue Medicare HMO Signature (HMO) covers primary care, specialist, and podiatry services with no copay and no coinsurance. Other services, including mental health, physical therapy, and telehealth, have copays ranging from $0 to $45 and no coinsurance, while chiropractic services are partially covered as other chiropractic services are not covered.
Preventive Services See details
Community Blue Medicare HMO Signature (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay, though home and bathroom safety devices require a 20% coinsurance, and several services—including health education, in-home safety assessments, nutritional therapy, and personal emergency response systems—are not covered.
Hearing Services See details
Hearing Services are partially covered under Community Blue Medicare HMO Signature (HMO), providing one routine hearing exam per year with no copay and no coinsurance, while fitting and evaluation services are not covered. Prescription hearing aids are covered with no coinsurance and a copay of $699 to $999 for up to two aids per year, though inner ear, outer ear, over-the-ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Community Blue Medicare HMO Signature (HMO) partially covers vision services with no copay and no coinsurance, offering one routine eye exam per year but excluding other eye exam services. Covered eyewear, including contacts and eyeglasses, also has no copay or coinsurance up to a combined maximum plan benefit of $400 every year.
Dental Services See details
Community Blue Medicare HMO Signature (HMO) offers partially covered dental services with no copay and no coinsurance up to an annual maximum of $3,000. Covered benefits include preventive and comprehensive care like exams, cleanings, and endodontics, while other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Community Blue Medicare HMO Signature (HMO) with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, have coinsurance ranging from no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by Community Blue Medicare HMO Signature (HMO) 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. You will pay no coinsurance to 50% coinsurance for durable medical equipment, 20% coinsurance for prosthetics and medical supplies, and no coinsurance to 20% coinsurance for diabetic supplies and therapeutic shoes.
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. Members pay no copay for lab services, $0 to $10 for diagnostic procedures, a $10 copay for outpatient X-rays, and copays starting at $200 for diagnostic radiological services and $60 for therapeutic radiological services.
Home Health Services See details
Home Health Services are fully covered under the Community Blue Medicare HMO Signature (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Community Blue Medicare HMO Signature (HMO) plan, as all related rehabilitation sub-services are excluded. This includes cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services, which receive no coverage under this plan.
Skilled Nursing Facility (SNF) See details
Community Blue Medicare HMO Signature (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Other Services are partially covered by Community Blue Medicare HMO Signature (HMO), which offers over-the-counter (OTC) items with no copay and no coinsurance up to $40 every three months. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this benefit.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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