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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 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 $6200.00 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 has an "Enhanced Alternative" drug benefit. There is no deductible for prescription drugs with this plan. In the initial coverage phase, you will pay a $0 copay for preferred generic drugs at a preferred pharmacy, and 25% coinsurance for standard generic drugs. For preferred brand drugs, you'll pay 50% coinsurance. Once your total drug costs reach $2,000, you enter the next phase.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers coverage for a wide range of services. Inpatient hospital stays have a copay, while outpatient services, including ambulance, emergency, and primary care, have varying copays. The plan also covers preventive, hearing, vision, and dental services, with copays for exams and other services. Additional benefits include home health services with no copay, and coverage for medical equipment, diagnostic and radiological services, and skilled nursing facilities. The plan also includes coverage for home infusion bundled services, and dialysis services. However, it is important to note that some services, such as cardiac rehabilitation and certain other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Community Blue Medicare HMO Signature (HMO) plan. For Inpatient Hospital-Acute, there is a $295 copay per admission or stay, and Additional Days for Inpatient Hospital-Acute have no copay. 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 with a $245 copay, observation services with a $245 copay, ambulatory surgical center services with a $195 copay, outpatient substance abuse services with a $45 copay for individual and group sessions, and outpatient blood services. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the Community Blue Medicare HMO Signature (HMO) plan. There is no information about the cost of these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a $250 copay, with no coinsurance. Transportation services to a plan-approved health-related location are covered, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, and Urgently Needed Services have a $50 copay; both have no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $250 copay; all have no coinsurance.
Primary Care See details
The Community Blue Medicare HMO Signature (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $25 copay, mental health specialty services with a $40 copay for individual and group sessions, podiatry services with a $25 copay for routine foot care, other healthcare professional services with a copay ranging from $0 to $25, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a copay ranging from $0 to $50, and opioid treatment program services with a $45 copay. Routine chiropractic care is limited to 4 visits per year.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, and additional preventive services. Additional preventive services may include a coinsurance of 20% for Home and Bathroom Safety Devices and Modifications, and a copay of $0-$25 for Remote Access Technologies. Some services, such as Health Education, Counseling Services, and Telemonitoring Services, are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $25 copay, and prescription hearing aids with a copay of $699-$999 depending on the type of hearing aid. Fitting/evaluation for hearing aids, OTC hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear, are not covered.
Vision Services See details
Vision services are covered by Community Blue Medicare HMO Signature (HMO), including routine eye exams with a $25 copay. Eyewear is covered with a combined maximum benefit of $350 every year, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Community Blue Medicare HMO Signature (HMO) plan covers dental services with a $25 copay for Medicare dental services. Other dental services, including oral exams, dental x-rays, cleaning, fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered, but with limitations on the number of visits and periodicity. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay with 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Community Blue Medicare HMO Signature (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered by Community Blue Medicare HMO Signature (HMO), including Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a 0-20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services, with a copay between $0 and $30, and lab services with no copay. The plan also covers diagnostic radiological services with a copay of at least $195, therapeutic radiological services with a copay of at least $60, and outpatient X-ray services with 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, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Community Blue Medicare HMO Signature (HMO) plan. Specifically, 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) services are covered by Community Blue Medicare HMO Signature (HMO) with prior authorization required. You will have no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items with a maximum benefit of $180 every three months, while acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, 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 are not covered.
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