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Security Blue HMO-POS ValueRx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Security Blue HMO-POS ValueRx (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Security Blue HMO-POS ValueRx (HMO-POS) in 2025, please refer to our full plan details page.
Security Blue HMO-POS ValueRx (HMO-POS) is a HMO-POS plan offered by Highmark Health available for enrollment in 2025 to people living in Western PA. This plan received an overall rating of 5 out of 5 stars in 2025.
It's important to know that Security Blue HMO-POS ValueRx (HMO-POS) 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 Security Blue HMO-POS ValueRx (HMO-POS).
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 Security Blue HMO-POS ValueRx (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8950.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8950.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Security Blue HMO-POS ValueRx (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for each drug, depending on the tier and pharmacy you use. For example, preferred generic drugs have a $13 copay at preferred pharmacies, while standard generic drugs have a $45 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, you will pay $14.30 per month.
Additional Benefits
The Security Blue HMO-POS ValueRx (HMO-POS) plan offers a range of benefits, including coverage for inpatient hospital stays with a $220 copay for the first five days, and no copay for days 6-90. The plan also covers outpatient services, emergency services, primary care, preventive services, hearing, vision, and dental services, each with varying copays or coinsurance. This plan includes coverage for ambulance services, home health services, and dialysis services, as well as medical equipment. Additionally, the plan covers skilled nursing facility stays with no copay for the first 20 days and a $214 copay for days 21-100.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, there is a $220 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, there is a $220 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, along with additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient services include outpatient hospital services with a $200 copay, observation services with a $200 copay per day, ambulatory surgical center services with a $175 copay, outpatient substance abuse services with a $40 copay for individual or group sessions, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Security Blue HMO-POS ValueRx (HMO-POS) plan. There is no information available about the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a $245 copay, and transportation services to any health-related location are covered for 24 one-way trips per year with a variety of transportation modes.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Security Blue HMO-POS ValueRx (HMO-POS) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $5 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $5 copay, and Worldwide Emergency Transportation has a $245 copay; there is no coinsurance for any of these services.
Primary Care See details
The Security Blue HMO-POS ValueRx (HMO-POS) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy with a $40 copay, physician specialist services with a $35 copay, mental health specialty services with a $40 copay for individual and group sessions, podiatry services with a $35 copay, other health care professional services with a copay between $0 and $35, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $40 copay. Routine chiropractic care is limited to 6 visits per year.
Preventive Services See details
The Security Blue HMO-POS ValueRx (HMO-POS) plan covers preventive services, including an annual physical exam. Additional preventive services are covered, and it also covers fitness benefits, enhanced disease management, kidney disease education services, and other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Home and Bathroom Safety Devices and Modifications have a 20% coinsurance, and Remote Access Technologies have a copay between $0 and $35. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, telemonitoring services, and counseling services are not covered.
Hearing Services See details
Hearing Services includes coverage for routine hearing exams with a $35 copay, and prescription hearing aids with a copay between $599 and $899, but does not cover fitting/evaluation for hearing aids, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids. Routine hearing exams are limited to one visit every year, and prescription hearing aids (all types) are limited to two visits every year.
Vision Services See details
Vision Services include eye exams with a $35 copay, and eyewear, including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $425 every year.
Dental Services See details
Dental services include Medicare dental services with a $35 copay, and other dental services with a $15 copay. Oral exams, dental x-rays, and prophylaxis (cleaning) are covered, but fluoride treatment is not covered. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Security Blue HMO-POS ValueRx (HMO-POS) plan, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%, and for other Medicare Part B drugs, there is coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs also have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Security Blue HMO-POS ValueRx (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment with varying coinsurance depending on the service. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Security Blue HMO-POS ValueRx (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $20, Lab Services have no copay, Diagnostic Radiological Services have a copay of at least $175, Therapeutic Radiological Services have a copay of at least $60, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by Security Blue HMO-POS ValueRx (HMO-POS) with no copay and no coinsurance, but prior authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but 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 Security Blue HMO-POS ValueRx (HMO-POS) plan, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services under the Security Blue HMO-POS ValueRx (HMO-POS) plan include a meal benefit for chronic illnesses, but acupuncture, over-the-counter items, 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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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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