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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 2026, 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 4.5 out of 5 stars in 2026.
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 $30.00. 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 offers prescription drug coverage with no drug deductible, allowing your benefits to start immediately. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies, or for a 3-month supply through preferred mail order. Tier 2 generic drugs carry a low $13 copay for a 1-month supply at preferred pharmacies, while standard pharmacies charge a $19 copay. Tier 3 preferred brand drugs require a $45 copay for a 1-month supply at preferred pharmacies and a $47 copay at standard pharmacies. Higher-tier medications transition to coinsurance, with Tier 4 non-preferred drugs requiring 35% coinsurance and Tier 5 specialty drugs requiring 33% coinsurance. Choosing preferred pharmacies and preferred mail-order options consistently provides the greatest savings under this plan.
Additional Benefits
The Security Blue HMO-POS ValueRx (HMO-POS) plan offers comprehensive medical coverage with affordable out-of-pocket costs, including no copay for primary care physician visits and a $35 copay for specialists. For inpatient hospital stays, members pay a $220 daily copay for the first five days and no copay for days six through 90. Emergency services are available with a $130 copay, which is waived if admitted, while urgent care visits require a $50 copay. Routine preventive services, annual physicals, and home health services are covered with no copay or coinsurance. Additionally, the plan features a $425 annual allowance for eyewear with no copay, routine vision and hearing exams for a $35 copay, and basic dental services with a $15 copay. Durable medical equipment and dialysis services are also covered, subject to a 20% coinsurance.
Inpatient Hospital See details
Security Blue HMO-POS ValueRx (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $220 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Security Blue HMO-POS ValueRx (HMO-POS) covers outpatient hospital and observation services with a $200 copay and no coinsurance, and ambulatory surgical center services with a $175 copay and no coinsurance. Outpatient substance abuse services require a $40 copay per session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Security Blue HMO-POS ValueRx (HMO-POS) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Security Blue HMO-POS ValueRx (HMO-POS) covers ground and air ambulance services with a $325 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Security Blue HMO-POS ValueRx (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $50 for urgent care, $130 for emergency care, and $325 for emergency transportation.
Primary Care See details
Security Blue HMO-POS ValueRx (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Physical, occupational, and psychiatric therapies have a $40 copay and no coinsurance, and chiropractic services are partially covered with a $15 copay and no coinsurance, though other chiropractic services are not covered.
Preventive Services See details
Security Blue HMO-POS ValueRx (HMO-POS) provides preventive services with no copay and no coinsurance for annual physicals, kidney disease education, and other routine screenings. Additional preventive benefits are partially covered, offering remote access technologies for a $0 to $35 copay (no coinsurance) and safety devices for a 20% coinsurance (no copay), but excluding health education, PERS, in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, and counseling.
Hearing Services See details
Security Blue HMO-POS ValueRx (HMO-POS) covers one annual routine hearing exam with a $35 copay and no coinsurance, but hearing aid fittings, evaluations, and OTC hearing aids are not covered. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $599.00 to $899.00 for up to two aids per year, though inner ear, outer ear, and over-the-ear types are excluded.
Vision Services See details
Security Blue HMO-POS ValueRx (HMO-POS) offers partially covered vision services, which include one routine eye exam per year for a $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a combined maximum plan benefit of $425 every year for contacts, frames, lenses, and upgrades.
Dental Services See details
Security Blue HMO-POS ValueRx (HMO-POS) partially covers dental services, requiring a $35 copay and no coinsurance for Medicare-covered dental, and a $15 copay and no coinsurance for other dental services. While exams, cleanings, and X-rays are covered with no coinsurance, several services including fluoride, restorative, endodontics, periodontics, prosthodontics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Security Blue HMO-POS ValueRx (HMO-POS) covers home infusion bundled services with no copay, subject to prior authorization. Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs require no coinsurance to 20% coinsurance.
Dialysis Services See details
Security Blue HMO-POS ValueRx (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under Security Blue HMO-POS ValueRx (HMO-POS) with no copays, though prior authorization is required for these services. Durable medical equipment, medical supplies, prosthetics, and diabetic shoes carry a 20% coinsurance, while diabetic supplies range from no coinsurance up to a 20% coinsurance.
Diagnostic and Radiological Services See details
Security Blue HMO-POS ValueRx (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic tests range from a $0 to $20 copay, outpatient X-rays have a $20 copay, and therapeutic and diagnostic radiological services require minimum copays of $60 and $175, respectively.
Home Health Services See details
Home health services are covered by Security Blue HMO-POS ValueRx (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Security Blue HMO-POS ValueRx (HMO-POS) covers Cardiac Rehabilitation Services with no copay and no coinsurance. While some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Security Blue HMO-POS ValueRx (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond Medicare-covered services are not covered.
Other Services See details
Security Blue HMO-POS ValueRx (HMO-POS) partially covers other services, offering a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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