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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 2026 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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay for 1-month and 3-month fills at preferred pharmacies or through preferred mail order. Standard pharmacies and standard mail order services incur copays of $7 to $21 for Tier 1 and $15 to $45 for Tier 2. Higher tier medications require coinsurance rather than flat copays, starting with a 20% coinsurance for Tier 3 preferred brand drugs. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance at all preferred and standard pharmacies. This clear cost structure allows you to easily estimate your out-of-pocket prescription expenses.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers affordable medical coverage featuring no copay and no coinsurance for primary care doctor visits, annual physicals, and home health services. Specialist visits require a $20 copay, while inpatient acute hospital stays incur a $325 copay per stay with no coinsurance. Emergency care is available with a $130 copay, which is waived upon hospital admission, alongside a $40 copay for urgent care visits. Additionally, the plan provides strong dental and vision benefits, including up to a $3,000 annual dental limit and a $400 annual eyewear allowance with no copay or coinsurance. Routine vision and hearing exams are accessible with a $20 copay, and prescription hearing aids carry a copay ranging from $699 to $999. Members also benefit from a $40 quarterly over-the-counter allowance and unlimited one-way transportation to approved medical locations with no copay.
Inpatient Hospital See details
Community Blue Medicare HMO Signature (HMO) covers inpatient acute hospital stays with no coinsurance and a $325 copay per stay, and inpatient psychiatric stays with no coinsurance and a $425 daily copay for days 1 through 3 (no copay for days 4 through 90). Prior authorization is required, and 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 $250 copay for outpatient hospital and daily observation services, and a $200 copay for ambulatory surgical center services. Outpatient substance abuse individual and group sessions require a $45 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
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
Community Blue Medicare HMO Signature (HMO) covers ambulance services with a $250 copay and no coinsurance, but only partially covers transportation services. While unlimited one-way trips to plan-approved health-related locations are offered with no copay and no coinsurance, 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, with the copay waived if you are admitted to the hospital within three days. Urgently needed services require a $40 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $40 to $250.
Primary Care See details
Primary care services are covered by Community Blue Medicare HMO Signature (HMO) with no copay and no coinsurance for primary care doctor visits, and a $20 copay with no coinsurance for specialist and therapy visits. Chiropractic benefits are partially covered with a $10 copay and no coinsurance for up to 4 routine visits per year, though 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. Some additional preventive services are also covered, such as memory fitness, remote access technologies (with a $0 to $20 copay), and home safety devices (with 20% coinsurance), though several sub-services like health education and personal emergency response systems 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 or deductible for one routine hearing exam per year, and a $699 to $999 copay with no coinsurance for up to two prescription hearing aids annually. Hearing aid fittings and evaluations, over-the-counter (OTC) hearing aids, and inner, outer, or over-the-ear prescription hearing aid types are not covered.
Vision Services See details
Vision Services are partially covered by Community Blue Medicare HMO Signature (HMO), as other eye exam services are not covered. Routine eye exams are covered once per year with a $20 copay and no coinsurance, while eyewear is covered with no copay, no coinsurance, and no deductible up to a $400 annual maximum.
Dental Services See details
Dental services are partially covered by Community Blue Medicare HMO Signature (HMO), which offers up to a $3,000 annual limit with no copay and no coinsurance for most preventive and comprehensive dental care, while Medicare-covered dental requires a $20 copay and no coinsurance. Other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Community Blue Medicare HMO Signature (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy and other drugs have 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
Community Blue Medicare HMO Signature (HMO) covers medical equipment with no copays, subject to prior authorization. Coinsurance ranges from no coinsurance up to 50% for durable medical equipment, is 20% for prosthetics and medical supplies, and ranges from no coinsurance up to 20% for diabetic equipment and supplies.
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. Lab services have no copay, outpatient X-rays require a $10 copay, and diagnostic procedures range from a $0 to $10 copay. Diagnostic and therapeutic radiological services carry minimum copays of $200 and $60, respectively.
Home Health Services See details
Home Health Services are covered by Community Blue Medicare HMO Signature (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Community Blue Medicare HMO Signature (HMO) provides cardiac rehabilitation services with no copay and no coinsurance; however, only some services are covered, and cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Community Blue Medicare HMO Signature (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Community Blue Medicare HMO Signature (HMO) provides partial coverage for other services, featuring over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $40 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this plan.
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