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Community Blue Medicare HMO Signature (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community Blue Medicare HMO Signature (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Community Blue Medicare HMO Signature (HMO) in 2026, please refer to our full plan details page.
Community Blue Medicare HMO Signature (HMO) is a HMO 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 Community Blue Medicare HMO Signature (HMO) 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 Community Blue Medicare HMO Signature (HMO).
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 Community Blue Medicare HMO Signature (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Community Blue Medicare HMO Signature (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay for 1-month or 3-month supplies filled at preferred pharmacies or through preferred mail order. If you use standard pharmacies or standard mail order, your cost-sharing ranges from a $7 to $15 copay for a 1-month supply and a $21 to $45 copay for a 3-month supply. For higher-tier medications, this plan transitions to coinsurance rather than flat copays. Tier 3 preferred brands require a 23% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance, whether you fill your prescription at a preferred or standard network pharmacy.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers affordable medical coverage with no copay and no coinsurance for primary care provider visits and routine preventive services. For specialist visits, inpatient hospital stays, and outpatient services, you will pay predictable copayments ranging from $20 to $275 with no coinsurance. Emergency and urgent care are also covered with flat copays, and home health services are available with no copay and no coinsurance. In addition to medical care, the plan features generous dental, vision, hearing, and over-the-counter benefits to help manage your everyday health costs. Dental care is covered up to a $3,000 annual limit with no copay for most covered services, while vision benefits include a $400 annual eyewear allowance with no copay or deductible. Members also benefit from routine hearing exams and a $95 quarterly allowance for over-the-counter health items with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Community Blue Medicare HMO Signature (HMO) with no coinsurance, requiring a $275 copay per stay for acute care and a $425 daily copay for the first three days of psychiatric care. Prior authorization is required for these services, and while unlimited additional days for acute care are covered with no copay, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Community Blue Medicare HMO Signature (HMO) covers outpatient hospital and daily observation services with a $245 copay and no coinsurance, and ambulatory surgical center services with a $175 copay and no coinsurance. Outpatient substance abuse services require a $45 copay per session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Community Blue Medicare HMO Signature (HMO) covers partial hospitalization services with no copay and no coinsurance. This ensures you can receive intensive outpatient mental health care with zero out-of-pocket costs.
Ambulance and Transportation Services See details
Community Blue Medicare HMO Signature (HMO) covers ground and air ambulance services with a $265 copay and no coinsurance. Transportation services are partially covered, offering unlimited one-way rides to plan-approved locations with no copay or coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
Community Blue Medicare HMO Signature (HMO) 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 require a $40 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $40 for urgent care, $130 for emergency care, and $265 for emergency transportation.
Primary Care See details
Community Blue Medicare HMO Signature (HMO) offers primary care provider visits with no copay and no coinsurance, while specialist visits require a $20 copay and no coinsurance. Chiropractic benefits are partially covered with a $15 copay and no coinsurance, as other chiropractic services are not covered, and other services like therapy, podiatry, and psychiatry feature copays ranging from $15 to $45 with no coinsurance.
Preventive Services See details
Community Blue Medicare HMO Signature (HMO) partially covers preventive services, offering annual physical exams, kidney disease education, and screenings with no copay and no coinsurance. Covered supplemental benefits include remote access technologies with a $0 to $20 copay and home and bathroom safety devices with a 20% coinsurance, while services like health education, personal emergency response systems, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Community Blue Medicare HMO Signature (HMO), featuring routine hearing exams with a $10 to $20 copay and no coinsurance, and prescription hearing aids with a $699 to $999 copay and no coinsurance. Fitting or evaluation exams, OTC hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered under this plan.
Vision Services See details
Vision services are partially covered by Community Blue Medicare HMO Signature (HMO), which provides one annual routine eye exam for a $20 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, offering a $400 annual maximum benefit for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Community Blue Medicare HMO Signature (HMO) provides partially covered dental services with an annual maximum benefit of $3,000, requiring a $20 copay and no coinsurance for Medicare-covered dental services, and no copay or coinsurance for other covered dental services. Orthodontics, implant services, maxillofacial prosthetics, other diagnostic dental services, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Community Blue Medicare HMO Signature (HMO) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Community Blue Medicare HMO Signature (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Community Blue Medicare HMO Signature (HMO) with no copays, though prior authorization is required. Durable medical equipment carries no coinsurance to 50% coinsurance, diabetic supplies range from no coinsurance to 20% coinsurance, and prosthetics, medical supplies, and diabetic shoes require 20% coinsurance.
Diagnostic and Radiological Services See details
Community Blue Medicare HMO Signature (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services feature no copay, diagnostic tests range from a $0 to $10 copay, outpatient X-rays cost $20, and diagnostic and therapeutic radiological services require minimum copays of $195 and $60, respectively.
Home Health Services See details
Community Blue Medicare HMO Signature (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Community Blue Medicare HMO Signature (HMO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance. However, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Community Blue Medicare HMO Signature (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage for additional days beyond the Medicare limit.
Other Services See details
Community Blue Medicare HMO Signature (HMO) partially covers Other Services, providing an over-the-counter (OTC) benefit with no copay and no coinsurance for up to $95 of items every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this plan.
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