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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. In the initial coverage phase, you'll pay a copay for each prescription based on the drug tier and the pharmacy you use. For example, a preferred generic drug has a $13 copay at a preferred pharmacy, while a standard generic drug has a $45 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy (LIS), your Part D premium is $14.30.
Additional Benefits
The Security Blue HMO-POS ValueRx (HMO-POS) plan offers coverage for a wide range of services. This plan includes inpatient hospital stays with a $220 copay for the first five days, and outpatient services with varying copays. You'll also find coverage for ambulance services with a $245 copay, emergency services with a $125 copay, and primary care services with copays between $0 and $40, depending on the service. Additional benefits of this plan include vision and dental coverage, with eye exams for a $35 copay and eyewear benefits. Hearing services are available with a $35 copay for routine exams, and prescription hearing aids. The plan also covers home health services with no copay, skilled nursing facility (SNF) with a $0 copay for the first 20 days, and offers a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $220 copay for days 1-5, and no copay for days 6-90, and for Inpatient Hospital Psychiatric, you will also pay a $220 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $200 copay, observation services with a $200 copay, ambulatory surgical center (ASC) services with a $175 copay, and outpatient substance abuse services with a $40 copay for individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Security Blue HMO-POS ValueRx (HMO-POS) plan. There is no information about the cost of this benefit in the provided snippet.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a $245 copay. Transportation Services to any health-related location are covered for up to 24 one-way trips per year, while 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 Security Blue HMO-POS ValueRx (HMO-POS) plan. Emergency Services has a $125 copay and no coinsurance, Urgently Needed Services has a $5 copay and no coinsurance, and Worldwide Emergency Services has varying copays depending on the service.
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 services 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
Preventive Services, including Medicare-covered preventive services and annual physical exams, are covered. Additional preventive services include Remote Access Technologies with a copay between $0 and $35, and Home and Bathroom Safety Devices and Modifications with 20% coinsurance. Health Education, In-Home Safety Assessment, Personal Emergency Response System, 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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Counseling Services, and Telemonitoring Services are not covered.
Hearing Services See details
Hearing Services include Routine Hearing Exams with a $35 copay, and Prescription Hearing Aids with a copay between $599 and $899, for up to two per year. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services include eye exams with a $35 copay, and eyewear with a combined maximum benefit of $425 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $35 copay, and Other Dental Services with a $15 copay. Oral exams, dental x-rays, prophylaxis (cleaning), and adjunctive general services are also covered, but fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a 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 a 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices and Medical Supplies with 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with copays applying to various services. Diagnostic Procedures/Tests have a copay between $0 and $20, Lab Services have no copay, Diagnostic Radiological Services have a copay of $175, Therapeutic Radiological Services have a copay of $60, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Security Blue HMO-POS ValueRx (HMO-POS) plan 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 not covered by the Security Blue HMO-POS ValueRx (HMO-POS) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Security Blue HMO-POS ValueRx (HMO-POS), with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Security Blue HMO-POS ValueRx (HMO-POS) plan does not cover 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. The plan does cover a meal benefit.
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