A non-government entity
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 2025, 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 5 out of 5 stars in 2025.
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. Additionally, this plan comes with a Part B Premium reduction of $6.00. 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 Maximum Out-Of-Pocket cost of $5500.00 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:
Sign up for Community Blue Medicare HMO Signature (HMO)
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 Community Blue Medicare HMO Signature (HMO) plan has an "Enhanced Alternative" drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay no copay for preferred generic drugs at a preferred pharmacy, $15 copay at a standard pharmacy, and coinsurance for other drugs. Once your total drug costs reach $2000, you enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers a range of benefits with varying costs. It covers inpatient hospital stays with a copay, outpatient services with copays ranging from $45 to $245, and ambulance services with a $275 copay. Emergency services have a $125 copay, and primary care and specialist visits have a $20 copay. Additional benefits include hearing and vision services, with copays for exams and coverage for eyewear. Dental services are available with a $20 copay and a $3,000 annual maximum. Home health services and skilled nursing facilities are covered, but some services may require prior authorization or have copays. The plan also offers coverage for over-the-counter items and medical equipment with coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered. For Inpatient Hospital-Acute, there is a $250 copay per admission or stay, and for Inpatient Hospital Psychiatric, there is a $425 copay for days 1-3, and no copay for days 4-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a $245 copay, Ambulatory Surgical Center (ASC) Services with a $175 copay, and Outpatient Substance Abuse Services with a $45 copay for both individual and group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by Community Blue Medicare HMO Signature (HMO). There is no information about the cost of services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all services. Ground and Air Ambulance Services have a $275 copay. Transportation Services to a Plan Approved Health-related Location are covered, and 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 by the Community Blue Medicare HMO Signature (HMO) plan. Emergency Services has a $125 copay with no coinsurance, and Urgently Needed Services has a $50 copay with no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $275 copay, all with no coinsurance.
Primary Care See details
The Community Blue Medicare HMO Signature (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $20 copay, mental health specialty services with a $40 copay for individual and group sessions, podiatry services with a $20 copay, other health care professional services with a copay between $0 and $20, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a copay between $0 and $50, and opioid treatment program services with a $45 copay.
Preventive Services See details
Preventive Services include Medicare-covered services, annual physical exams, and additional preventive services. Additional preventive services have a copay and coinsurance, and some services like Health Education, In-Home Safety Assessment, and others are not covered. Remote Access Technologies have a $0-$20 copay, and Home and Bathroom Safety Devices and Modifications have 20% coinsurance.
Hearing Services See details
Hearing exams are covered under the Community Blue Medicare HMO Signature (HMO) plan with a $20 copay, with routine hearing exams covered once per year. Prescription hearing aids are also covered, with a copay between $699 and $999 for prescription hearing aids of all types; however, fitting/evaluation for hearing aids, prescription hearing aids for the inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $20 copay, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. This plan offers a combined maximum of $350 per year for eyewear.
Dental Services See details
Under the Community Blue Medicare HMO Signature (HMO) plan, dental services include a $20 copay for Medicare dental services, with a $3,000 maximum benefit per year. Oral exams, x-rays, cleaning, and fluoride treatments are covered with limitations on the number of visits, and Orthodontic services are covered under Diagnostic and Preventive Dental. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. 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, coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Community Blue Medicare HMO Signature (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by Community Blue Medicare HMO Signature (HMO). Durable Medical Equipment (DME) has a 20% coinsurance, and Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have a 0-20% coinsurance and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Community Blue Medicare HMO Signature (HMO) plan. Diagnostic Procedures/Tests and Lab Services are not covered, while Diagnostic Radiological Services have a copay of up to $195, Therapeutic Radiological Services have a copay of up to $60, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Community Blue Medicare HMO Signature (HMO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Community Blue Medicare HMO Signature (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Community Blue Medicare HMO Signature (HMO) plan covers over-the-counter items with a maximum benefit of $220 every three months, but does not cover acupuncture, meal benefits, or Dual Eligible SNPs with Highly Integrated Services. Additionally, the plan does not cover 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.
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