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Security Blue HMO-POS Standard (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Security Blue HMO-POS Standard (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 Standard (HMO-POS) in 2026, please refer to our full plan details page.
Security Blue HMO-POS Standard (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 Standard (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 Standard (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 Standard (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $122.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $19.00. 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 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 Standard (HMO-POS) plan offers a $0 drug deductible, meaning your prescription drug benefits start immediately without any out-of-pocket deductible costs. Under this plan, Tier 1 preferred generic medications have no copay for a 1-month or 3-month supply at standard pharmacies and standard mail order. Tier 2 generic drugs require a $13 copay for a 1-month supply at standard pharmacies, with 3-month options costing $39 at standard pharmacies or $32.50 through standard mail order. For higher tier medications, Tier 3 preferred brand drugs have a $44 copay for a 1-month supply at standard pharmacies, while Tier 4 non-preferred drugs require a $100 copay. Ordering a 3-month supply of these medications through standard mail order lowers your costs to $110 for Tier 3 and $250 for Tier 4. Tier 5 specialty drugs require a 33% coinsurance for a 1-month supply at both standard pharmacies and standard mail order.
Additional Benefits
The Security Blue HMO-POS Standard (HMO-POS) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive screenings, and home health services. For specialized care, members pay a $30 copay for specialist visits and a $335 copay per stay for inpatient hospital services, both with no coinsurance. Emergency care is covered with a $130 copay, and outpatient hospital services carry a $175 copay. This plan also includes valuable supplemental benefits, featuring routine dental services with a $15 copay and no coinsurance, as well as routine hearing exams with a $30 copay. Vision care is supported with a $30 copay for annual eye exams and up to a $425 annual limit for eyewear with no copay. Additionally, members can access up to 24 health-related one-way transportation trips per year and diagnostic lab services with no copay.
Inpatient Hospital See details
Security Blue HMO-POS Standard (HMO-POS) partially covers inpatient hospital services with a $335 copay per stay and no coinsurance for Medicare-covered acute and psychiatric care. Prior authorization is required, and while unlimited additional acute days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Security Blue HMO-POS Standard (HMO-POS) covers outpatient services with no coinsurance, featuring a $175 copay for outpatient hospital and observation services, and a $125 copay for ambulatory surgical center services. Outpatient substance abuse services require a $30 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under Security Blue HMO-POS Standard (HMO-POS) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Security Blue HMO-POS Standard (HMO-POS) covers ground and air ambulance services with a $270 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Security Blue HMO-POS Standard (HMO-POS) covers emergency services with a $130 copay, which is waived if admitted to the hospital within three days, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $50, and $270, respectively.
Primary Care See details
Security Blue HMO-POS Standard (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialists, physical therapy, and mental health services require a $30 copay and no coinsurance. Chiropractic benefits are partially covered, offering routine care for a $15 copay and no coinsurance for up to 8 visits per year, while other chiropractic services are not covered. Additional telehealth benefits are also available with a $0 to $50 copay and no coinsurance.
Preventive Services See details
Security Blue HMO-POS Standard (HMO-POS) covers preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, and other screenings. Additional preventive benefits are partially covered, including remote access technologies with a $0 to $30 copay and home safety devices with a 20% coinsurance, but health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, telemonitoring, and counseling services are not covered.
Hearing Services See details
Hearing Services are partially covered by Security Blue HMO-POS Standard (HMO-POS), offering one routine hearing exam annually for a $30 copay and no coinsurance, and up to two prescription hearing aids per year with a $599 to $899 copay and no coinsurance. Fitting or evaluation exams, over-the-counter (OTC) hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aid types are not covered.
Vision Services See details
Vision Services are partially covered under Security Blue HMO-POS Standard (HMO-POS), featuring a $30 copay and no coinsurance for one annual routine eye exam, while other eye exam services are not covered. Covered eyewear—including contact lenses, eyeglasses, and upgrades—has no copay, no coinsurance, and no deductible, up to a $425 maximum limit per year.
Dental Services See details
Security Blue HMO-POS Standard (HMO-POS) provides partially covered dental services, including Medicare-covered dental for a $30 copay and other dental services for a $15 copay, with no coinsurance for either. Routine oral exams, cleanings, x-rays, and adjunctive general services are covered with no coinsurance, but the plan does not cover restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, orthodontics, fluoride, and other diagnostic or preventive services.
Home Infusion bundled Services See details
Security Blue HMO-POS Standard (HMO-POS) covers home infusion bundled services with no copay, requiring prior authorization. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no copay and a coinsurance ranging from no coinsurance to 20%, while covered Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Security Blue HMO-POS Standard (HMO-POS) covers dialysis services with no copay and 20% coinsurance.
Medical Equipment See details
Security Blue HMO-POS Standard (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. Covered diabetic equipment and supplies also feature no copay and a coinsurance ranging from no coinsurance up to 20%, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Security Blue HMO-POS Standard (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic procedures carry a $0 to $10 copay, outpatient X-rays have a $20 copay, and therapeutic and diagnostic radiological services require minimum copays of $60 and $125, respectively.
Home Health Services See details
Home Health Services are covered under the Security Blue HMO-POS Standard (HMO-POS) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Security Blue HMO-POS Standard (HMO-POS) with no copay and no coinsurance. While some services are covered, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Security Blue HMO-POS Standard (HMO-POS) with no coinsurance and requires prior authorization, but does not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 copay per day for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services under Security Blue HMO-POS Standard (HMO-POS) are partially covered, 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 plan.
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