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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 $104.00. 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 coverage begins immediately without any upfront out-of-pocket deductible costs. Tier 1 preferred generic drugs are highly affordable, requiring no copay for a 1-month or 3-month supply at standard pharmacies and through standard mail order. For Tier 2 generic medications, you will pay a $13 copay for a 1-month supply at standard pharmacies, which can be optimized to a $32.50 copay for a 3-month supply via standard mail order. Brand-name and specialty medications under this plan have structured copays and coinsurance depending on the tier. Tier 3 preferred brand drugs have a $44 copay for a 1-month standard pharmacy supply, while Tier 4 non-preferred drugs cost $100 for a 1-month supply. Finally, Tier 5 specialty drugs require a 33% coinsurance for a 1-month supply at both standard pharmacies and through standard mail order.
Additional Benefits
The Security Blue HMO-POS Standard (HMO-POS) plan offers robust medical coverage with predictable out-of-pocket costs, featuring no copay for primary care visits and a $30 copay for specialists. Inpatient hospital stays require a $335 copay per stay, while outpatient hospital visits have a $175 copay, with no coinsurance required for either service. Emergency room visits carry a $130 copay, and ground or air ambulance transportation is covered with a $290 copay. Preventive care, routine dental cleanings, and home health services are fully covered with no copay or coinsurance. Routine vision and hearing exams require a $30 copay, and the plan includes a $425 annual allowance for eyewear alongside coverage for prescription hearing aids. Durable medical equipment and dialysis services require no copay and a 20% coinsurance, while skilled nursing facility stays feature no copay for the first 20 days.
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, requiring prior authorization. While unlimited additional days for acute care are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Security Blue HMO-POS Standard (HMO-POS) covers outpatient hospital and observation services with a $175 copay and no coinsurance, and ambulatory surgical center services with a $125 copay and no coinsurance. Outpatient substance abuse services require a $30 copay per individual or group session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Security Blue HMO-POS Standard (HMO-POS) covers partial hospitalization benefits 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 $290 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, but 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 (waived if admitted to the hospital within three days) and no coinsurance, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency services are also covered with no coinsurance, featuring copays of $130 for emergency care, $50 for urgent care, and $290 for emergency transportation.
Primary Care See details
Primary care services under Security Blue HMO-POS Standard (HMO-POS) are covered with no copay and no coinsurance for primary care provider visits, while specialist, therapy, and mental health services generally require a $30 copay and no coinsurance. Routine chiropractic care is partially covered with a $15 copay and no coinsurance for up to 8 visits per year, but other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Security Blue HMO-POS Standard (HMO-POS), offering annual physicals, kidney disease education, and other screenings with no copay and no coinsurance, remote access technologies for a $0 to $30 copay with no coinsurance, and home safety devices for a 20% coinsurance with no copay. Excluded services include 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, home-based palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, and counseling.
Hearing Services See details
Hearing services are partially covered by Security Blue HMO-POS Standard (HMO-POS), featuring one routine hearing exam per year for a $30.00 copay and no coinsurance. Up to two prescription hearing aids are covered annually with a copay ranging from $599.00 to $899.00 and no coinsurance, while fitting evaluations, OTC hearing aids, and inner, outer, or over-the-ear prescription aids are not covered.
Vision Services See details
Security Blue HMO-POS Standard (HMO-POS) offers partially covered vision services with no deductibles, including one routine eye exam per year for a $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $425 annual combined maximum for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Security Blue HMO-POS Standard (HMO-POS) offers partially covered dental services, including Medicare-covered dental with a $30 copay and no coinsurance, and other dental services for a $15 copay and no coinsurance. Covered benefits include cleanings, exams, x-rays, and adjunctive general services with no copay and no coinsurance. However, restorative, endodontic, periodontic, prosthodontic, implant, orthodontic, oral surgery, and fluoride treatments are not covered.
Home Infusion bundled Services See details
Security Blue HMO-POS Standard (HMO-POS) covers home infusion bundled services with no copay, subject to prior authorization. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and range from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Security Blue HMO-POS Standard (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Security Blue HMO-POS Standard (HMO-POS) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with no copays and a 20% coinsurance. Diabetic supplies specifically range from no coinsurance to 20% coinsurance, and prior authorization is required for these covered services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Security Blue HMO-POS Standard (HMO-POS) with no coinsurance, though prior authorization is required. Outpatient lab services have no copay, diagnostic tests have up to a $10 copay, and radiological services require copays of $20 for X-rays, at least $60 for therapeutic radiology, and at least $125 for diagnostic radiology.
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. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
Security Blue HMO-POS Standard (HMO-POS) does not cover Cardiac Rehabilitation Services, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Security Blue HMO-POS Standard (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 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by the Security Blue HMO-POS Standard (HMO-POS) plan, which offers a limited-duration 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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