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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, you can benefit from no copay on Tier 1 preferred generics and Tier 2 generics when using a preferred pharmacy or preferred mail order. If you utilize a standard pharmacy, Tier 1 drugs require a $7 copay and Tier 2 drugs require a $15 copay for a one-month supply. For brand-name and specialty medications, the plan charges a percentage of the drug cost rather than a flat copayment. Tier 3 preferred brand drugs carry a 23% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance. These coinsurance rates apply across all preferred, standard, and mail-order pharmacy options.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan features robust coverage with no copay for primary care visits, while specialist visits require a $25 copay and no coinsurance. For hospital care, inpatient acute stays carry a $300 copay, and emergency room visits have a $130 copay, both with no coinsurance. Outpatient hospital services are covered with a $275 copay, and diagnostic lab services require no copay. This plan also includes valuable supplemental benefits, such as routine dental coverage up to a $3,000 annual limit and routine vision eyewear up to $400 annually, both with no copay. Additionally, you can receive over-the-counter items with no copay up to $95 every three months, and routine hearing exams require a small $10 copay. While home health services have no copay, other needs like durable medical equipment may require coinsurance ranging from 0% to 50%.
Inpatient Hospital See details
Inpatient hospital services are covered by Community Blue Medicare HMO Signature (HMO) with no coinsurance, requiring a $300 copay per stay for acute care and a $425 daily copay for days 1 through 3 (with no copay for days 4 through 90) for psychiatric care. Prior authorization is required, and non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Community Blue Medicare HMO Signature (HMO) covers outpatient services 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 sessions require a $45 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Community Blue Medicare HMO Signature (HMO) with no copay and no coinsurance. You will pay nothing out-of-pocket for these covered services.
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, while transportation services are partially covered. Under this plan, you will pay no copay and no coinsurance for unlimited one-way trips to plan-approved health-related locations, though transportation to any 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 with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $40, and $265, respectively.
Primary Care See details
Primary care and specialist services under the Community Blue Medicare HMO Signature (HMO) are covered with no coinsurance, featuring no copay for primary care visits and a $25 copay for specialists. Other professional services like therapy, podiatry, and mental health have copays ranging from $0 to $45 with no coinsurance, though chiropractic benefits are only partially covered as other chiropractic services are not covered.
Preventive Services See details
Community Blue Medicare HMO Signature (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering remote access technologies with a $0 to $25 copay and no coinsurance, and home and bathroom safety devices with a 20% coinsurance and no copay, while sub-services like health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by Community Blue Medicare HMO Signature (HMO) with no coinsurance. Covered benefits include annual routine exams for a $10 copay and up to two prescription hearing aids per year for a $699 to $999 copay, while fitting/evaluation exams, OTC hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Community Blue Medicare HMO Signature (HMO), which excludes other eye exam services but covers one routine eye exam annually with a $25 copay and no coinsurance. Eyewear is covered with no copay and no coinsurance up to a $400 annual maximum for contact lenses, eyeglass lenses, frames, and upgrades.
Dental Services See details
Community Blue Medicare HMO Signature (HMO) covers Medicare-covered dental services for a $25 copay and no coinsurance, alongside other covered dental services with no copay and no coinsurance up to a $3,000 annual maximum. This benefit is partially covered, as other diagnostic services, other preventive services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Community Blue Medicare HMO Signature (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Medicare Part B drugs, including chemotherapy and insulin, have a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
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
Medical equipment is covered by Community Blue Medicare HMO Signature (HMO) with no copay, though prior authorization is required. Coinsurance ranges from 0% to 50% for durable medical equipment, 20% for prosthetics and medical supplies, and 0% to 20% for diabetic supplies and therapeutic shoes.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Community Blue Medicare HMO Signature (HMO) with no coinsurance, though prior authorization is required. Lab services have no copay, outpatient diagnostic tests range from a $0 to $10 copay, outpatient X-rays have 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 by Community Blue Medicare HMO Signature (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Community Blue Medicare HMO Signature (HMO) plan, as all sub-services, including intensive cardiac, pulmonary, and SET for PAD services, are excluded from coverage. Although the category technically lists no copay and no coinsurance, there is no practical coverage for any of these rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Community Blue Medicare HMO Signature (HMO) with no coinsurance and requires prior authorization, but does not require 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, though additional days beyond the 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 maximum of $95 every three months. Acupuncture and meal benefits are not covered under this plan.
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