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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 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 $119.00. 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)
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Drug Coverage
The Security Blue HMO-POS Standard (HMO-POS) plan has an enhanced alternative drug benefit with a $0 deductible. During the initial coverage phase, you will pay a copay for your prescriptions. For example, you will pay a $13.00 copay for preferred generic drugs at a standard pharmacy. For standard generic drugs, the copay is $44.00. For preferred brand drugs, the copay is $100.00. For non-preferred drugs, you will pay 33% coinsurance. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Security Blue HMO-POS Standard (HMO-POS) plan offers a variety of benefits, including coverage for inpatient and outpatient services, with copays ranging from $0 to $335 depending on the service. This plan also covers primary care, preventive services, hearing, vision, and dental services. Additional benefits include ambulance and transportation services, emergency services, home health services, and skilled nursing facility care, with varying copays and coinsurance. The plan also covers durable medical equipment, prosthetic devices, and home infusion bundled services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will have a $335 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare covered stays and upgrades are not covered. Additional days for Inpatient Hospital Psychiatric, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $175 copay, observation services with a $175 copay, ambulatory surgical center (ASC) services with a $125 copay, outpatient substance abuse services with a $30 copay for both individual and group sessions, and outpatient blood services. Prior authorization is required for outpatient hospital services and ASC services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Security Blue HMO-POS Standard (HMO-POS) plan. The plan covers the benefit without any additional cost.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $200 copay, and transportation services to a plan-approved health-related location, with 24 one-way trips per year. Transportation services to any health-related location are not covered. There is no coinsurance for any of these services.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Security Blue HMO-POS Standard. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a $5 copay and no coinsurance, and Worldwide Emergency Coverage has a $125 copay.
Primary Care See details
The Security Blue HMO-POS Standard (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $15 copay, occupational therapy has a $30 copay, physician specialist services have a $30 copay, individual and group mental health sessions have a $30 copay, podiatry services have a $30 copay, other health care professional services have a copay between $0 and $30, individual and group psychiatric sessions have a $30 copay, physical therapy and speech-language pathology services have a $30 copay, and opioid treatment program services have a $30 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, additional preventive services, kidney disease education, and other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Some services such as 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, Telemonitoring Services, and Counseling Services are not covered. Home and Bathroom Safety Devices and Modifications have 20% coinsurance, while Remote Access Technologies have a copay between $0 and $30.
Hearing Services See details
Hearing Services include routine hearing exams with a $30 copay, and prescription hearing aids with a copay between $599 and $899 for all types of prescription hearing aids. Fitting/evaluation for hearing aids, prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $30 copay, and eyewear with a combined maximum benefit of $425 every year. Eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, contact lenses, and upgrades are also covered.
Dental Services See details
Dental services include a $30 copay for Medicare dental services and a $15 copay for other dental services. Oral exams, dental x-rays, and prophylaxis (cleaning) are covered, but fluoride treatment is not covered. Orthodontic services are covered, but 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, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Security Blue HMO-POS Standard (HMO-POS) plan. This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with a 20% coinsurance. Medical Supplies and Diabetic Equipment are also covered, with 20% coinsurance for Medical Supplies, and Diabetic Supplies with 0-20% coinsurance and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $10, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $125, Therapeutic Radiological Services have a copay of at most $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 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 technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or 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 and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Security Blue HMO-POS Standard (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 for chronic illnesses.
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