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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 generic medications, the plan offers cost savings, including no copay for Tier 1 preferred generics and Tier 2 generics when filled at a preferred pharmacy or through preferred mail order. If you use a standard pharmacy, Tier 1 drugs have a $7 copay and Tier 2 drugs have a $15 copay for a one-month supply. For brand-name and specialty medications, your costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 23% coinsurance at all pharmacy and mail order locations. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, whether you use a preferred or standard pharmacy.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan provides comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive screenings, and home health care. Specialist visits require a $20 copay, while inpatient hospital stays require a $300 copay per stay and outpatient hospital services carry a $275 copay. Emergency room care is covered with a $130 copay, which is waived if you are admitted, and urgent care visits require a $40 copay. For additional wellness protection, the plan offers dental services and eyewear with no copay and no coinsurance up to annual maximums of $3,000 and $400, respectively. Routine hearing exams carry a $10 copay, and prescription hearing aids are covered with copays ranging from $699 to $999. Members also receive a $95 allowance every three months for over-the-counter items with no copay, while durable medical equipment is covered with no copay and coinsurance up to 50%.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Community Blue Medicare HMO Signature (HMO) with no coinsurance, requiring prior authorization and a $300 copay per stay for acute care. Psychiatric stays require a $425 daily copay for days 1 through 3 (with no copay for days 4 through 90), while upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under the Community Blue Medicare HMO Signature (HMO) with no coinsurance, featuring a $275 copay for outpatient hospital and daily observation services, and a $225 copay for ambulatory surgical center services. Outpatient substance abuse services require a $45 copay per session with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Community Blue Medicare HMO Signature (HMO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Community Blue Medicare HMO Signature (HMO), featuring a $375 copay and no coinsurance for ground and air ambulance trips. Unlimited one-way transportation to plan-approved health-related locations is also covered with no copay and no coinsurance, though 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, with the copay waived if 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 $130 for emergency, $40 for urgent care, and $375 for transportation.
Primary Care See details
Community Blue Medicare HMO Signature (HMO) provides primary care physician services with no copay and no coinsurance, and specialist visits for a $20 copay and no coinsurance. Additional services like physical therapy, mental health, and podiatry have copays ranging from $15 to $45 with no coinsurance, though chiropractic care is only partially covered as other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Community Blue Medicare HMO Signature (HMO), offering annual physicals, kidney disease education, and screenings with no copay and no coinsurance. Covered supplemental benefits include remote access technologies ($0 to $20 copay, no coinsurance) and home safety devices (no copay, 20% coinsurance), while health education, PERS, in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, and counseling are not covered.
Hearing Services See details
Community Blue Medicare HMO Signature (HMO) partially covers hearing services, offering one routine hearing exam per year with a $10 copay and no coinsurance, though fitting and evaluation exams are not covered. Prescription hearing aids are covered with no coinsurance and copays ranging from $699 to $999, but OTC hearing aids and specific inner, outer, or over-the-ear models are not covered.
Vision Services See details
Community Blue Medicare HMO Signature (HMO) partially covers vision services with no deductible, offering one routine eye exam per year for a $20 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear, including lenses, frames, and contacts, features no copay and no coinsurance up to a $400 annual maximum.
Dental Services See details
Community Blue Medicare HMO Signature (HMO) partially covers dental services, offering Medicare-covered dental with a $20 copay and no coinsurance, and other covered dental services with no copay and no coinsurance up to a $3,000 annual maximum. Uncovered sub-services include orthodontics, implant services, maxillofacial prosthetics, other diagnostic dental services, and other preventive dental services.
Home Infusion bundled Services See details
Community Blue Medicare HMO Signature (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Covered Medicare Part B chemotherapy, radiation, and other drugs require between no coinsurance and 20% coinsurance, while Medicare Part B insulin drugs carry a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Community Blue Medicare HMO Signature (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Community Blue Medicare HMO Signature (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and prior authorization required. Coinsurance costs range from 0% to 50% for durable medical equipment, stand at 20% for prosthetics and medical supplies, and range from 0% to 20% for diabetic supplies and therapeutic shoes.
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. Diagnostic lab services have no copay, other diagnostic procedures range from a $0 to $10 copay, outpatient X-rays carry a $20 copay, and diagnostic and therapeutic radiological services require minimum copays of $210 and $60, respectively.
Home Health Services See details
Home Health Services are covered under the Community Blue Medicare HMO Signature (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Community Blue Medicare HMO Signature (HMO) features Cardiac Rehabilitation Services where some services are covered with no copay and no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, 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, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Community Blue Medicare HMO Signature (HMO) partially covers Other Services, offering Over-the-Counter (OTC) items with no copay and no coinsurance up to a $95 maximum benefit every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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