A non-government entity
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 2025, 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 5 out of 5 stars in 2025.
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 $140.00. 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:
Sign up for Security Blue HMO-POS Standard (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Security Blue HMO-POS Standard (HMO-POS) plan has an Enhanced Alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions. For example, you will pay a $13 copay for a preferred generic drug at a standard pharmacy. You will pay 33% coinsurance for a non-preferred drug. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your covered drugs.
Additional Benefits
The Security Blue HMO-POS Standard (HMO-POS) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $335 copay per admission, while outpatient services range from no copay to a $175 copay. Emergency services have a $125 copay, and ambulance services have a $200 copay. This plan includes coverage for primary care, hearing, vision, and dental services. Primary care and specialist visits have a $15-$30 copay, routine hearing exams have a $30 copay, and prescription hearing aids have a copay between $599 and $899. Vision services include eye exams with a $30 copay and eyewear with a benefit of $425 every year, and dental services have a $15-30 copay. Other benefits include home health services with no copay, and skilled nursing facility services with a $0 copay for days 1-20 and $214 for days 21-100.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a $335 copay per admission or stay for Medicare-covered stays. Additional Days for Inpatient Hospital-Acute has no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, 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, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital and Observation Services have a $175 copay, Ambulatory Surgical Center (ASC) Services have a $125 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a $30 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Security Blue HMO-POS Standard (HMO-POS) plan. There is no additional cost information available for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services with a $200 copay. Transportation services to a plan-approved health-related location are also covered, with up to 24 one-way trips per year. 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 under the Security Blue HMO-POS Standard plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $5 copay, and Worldwide Emergency Transportation has a $200 copay. There is no coinsurance for these services.
Primary Care See details
The Security Blue HMO-POS Standard (HMO-POS) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $30 copay, and mental health specialty services with a $30 copay for individual or group sessions. Podiatry services and routine foot care have a $30 copay, other health care professional services have a copay between $0 and $30, psychiatric services for individual or group sessions have a $30 copay, physical therapy and speech-language pathology services have a $30 copay, telehealth benefits have a copay between $0 and $30, and opioid treatment program services have a $30 copay.
Preventive Services See details
Preventive Services includes coverage for Medicare-covered preventive services with no copay, annual physical exams, additional preventive services, kidney disease education, and other preventive services. Some services, such as Health Education, Counseling Services, and Telemonitoring Services are not covered.
Hearing Services See details
Hearing Services include coverage for routine hearing exams with a $30 copay for each exam, and for prescription hearing aids with a copay between $599 and $899 per year, but fitting/evaluation for hearing aids, prescription hearing aids for inner ear, outer ear, and over-the-ear, and OTC hearing aids are not covered. The plan covers one routine hearing exam per year.
Vision Services See details
Vision services include eye exams with a $30 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 includes coverage for Medicare Dental Services with a $30 copay, and Other Dental Services with a $15 copay. Oral exams, dental x-rays, prophylaxis (cleaning), and adjunctive general services are covered. 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, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Security Blue HMO-POS Standard (HMO-POS) plan. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment benefits are covered by Security Blue HMO-POS Standard (HMO-POS). Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a copay between $0 and $10, lab services with no copay, diagnostic radiological services with a copay of at least $125, therapeutic radiological services with a copay of at least $60, and outpatient X-ray services with a $20 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Security Blue HMO-POS Standard (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Security Blue HMO-POS Standard (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, with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services, including acupuncture, over-the-counter items, dual eligible SNPs, 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. The plan does cover a meal benefit for a chronic illness.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved