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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 2026 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 prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, there is no copay for 1-month or 3-month supplies filled at preferred pharmacies or through preferred mail order. Standard pharmacies and standard mail order options charge a $7 copay for Tier 1 and a $15 copay for Tier 2 for a 1-month supply. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 23% coinsurance for both 1-month and 3-month supplies at all pharmacy types. Tier 4 non-preferred drugs and Tier 5 specialty drugs both incur a 25% coinsurance for your prescription needs.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers comprehensive medical coverage with predictable cost-sharing and no coinsurance for many key services. You will pay no copay for primary care doctor visits, annual physicals, and home health services, while specialist visits require a $25 copay. For hospital care, inpatient acute stays have a $300 copay, outpatient hospital services carry a $245 copay, and emergency room visits require a $130 copay. This plan also features robust dental, vision, hearing, and daily wellness benefits to help lower your out-of-pocket expenses. Dental care is covered with no copay up to a $3,000 annual maximum, and routine vision exams require a $25 copay alongside a $400 annual allowance for eyewear with no deductible. Additionally, members receive a $70 over-the-counter allowance every three months with no copay, and routine hearing exams feature a copay between $10 and $25.
Inpatient Hospital See details
Inpatient hospital services are covered by Community Blue Medicare HMO Signature (HMO) with no coinsurance and require prior authorization, featuring a $300 copay per stay for acute care and a $425 daily copay for days 1 through 3 of psychiatric care (with no copay for days 4 through 90). While unlimited additional acute care days are covered with no copay, upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Community Blue Medicare HMO Signature (HMO) covers outpatient hospital and observation services with a $245 copay and no coinsurance, and ambulatory surgical center services with a $175 copay and no coinsurance. Outpatient substance abuse sessions require a $45 copay with no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Community Blue Medicare HMO Signature (HMO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Community Blue Medicare HMO Signature (HMO) plan, with ground and air ambulance services requiring a $375 copay and no coinsurance. Transportation services are partially covered, offering unlimited rides to plan-approved locations with no copay and no coinsurance, while 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, with the copay waived if you are admitted to the hospital within 3 days. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $40, and $375 respectively.
Primary Care See details
Primary care benefits under Community Blue Medicare HMO Signature (HMO) feature no copay and no coinsurance for primary care physician visits, and a $25 copay with no coinsurance for specialist visits. Chiropractic services are partially covered, excluding other chiropractic services, with a $15 copay and no coinsurance, while therapy, mental health, podiatry, and telehealth services are covered with copays ranging from $0 to $45 and no coinsurance.
Preventive Services See details
Preventive services are covered by Community Blue Medicare HMO Signature (HMO) with no copay and no coinsurance for annual physicals, kidney disease education, and standard screenings. Additional preventive benefits are partially covered, featuring memory fitness, remote access technologies with a $0 to $25 copay, and home safety devices with 20% coinsurance. Sub-services that are not covered include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, and counseling.
Hearing Services See details
Hearing Services under the Community Blue Medicare HMO Signature (HMO) are partially covered, offering routine hearing exams with a $10 to $25 copay and no coinsurance, while fitting and evaluation exams are not covered. Prescription hearing aids are also partially covered with a $699 to $999 copay and no coinsurance, but inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Community Blue Medicare HMO Signature (HMO) provides partially covered vision services, as other eye exam services are not covered. Routine eye exams are covered once per year with a $25 copay, no coinsurance, and no deductible, while eyewear is covered with no copay, no coinsurance, no deductible, and a $400 annual allowance for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental Services are partially covered by Community Blue Medicare HMO Signature (HMO), offering Medicare-covered dental services with a $25 copay and no coinsurance, and other covered dental services with no copay and no coinsurance up to a $3,000 annual maximum. While many preventive and comprehensive services are covered, the plan does not cover other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Community Blue Medicare HMO Signature (HMO) with no copay and no coinsurance, subject to prior authorization and step therapy. Associated Medicare Part B drugs, including chemotherapy, require no copay and no coinsurance to 20% coinsurance, while covered insulin requires a $35 copay and no coinsurance 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
Medical equipment is covered by Community Blue Medicare HMO Signature (HMO) with no copays, 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 equipment 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, subject to prior authorization. Under this benefit, there is no copay for lab services, a copay of up to $10 for diagnostic tests, a $20 copay for X-rays, and minimum copays of $60 for therapeutic and $195 for diagnostic radiological services.
Home Health Services See details
Home Health Services are covered by Community Blue Medicare HMO Signature (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Community Blue Medicare HMO Signature (HMO) covers some services under its Cardiac Rehabilitation Services benefit 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
Skilled nursing facility (SNF) care is partially covered by Community Blue Medicare HMO Signature (HMO), as additional days beyond the standard Medicare-covered limit are not covered. There is no coinsurance and no copay for days 1 to 20, followed by a $218 daily copay for days 21 to 100, with prior authorization required and no prior three-day hospital stay needed.
Other Services See details
Community Blue Medicare HMO Signature (HMO) partially covers other services, offering an over-the-counter (OTC) benefit of $70 every three months with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone coverage are not covered under this benefit.
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