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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 budget-friendly generic medications, Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs have no copay when filled at a preferred pharmacy or through preferred mail order. If you utilize a standard pharmacy instead, Tier 1 drugs require a $7 copay and Tier 2 drugs require a $15 copay for a one-month supply. For higher-tier medications, this plan transitions to a percentage-based coinsurance cost-sharing model. Tier 3 (Preferred Brand) drugs incur a 23% coinsurance, while Tier 4 (Non-Preferred Drug) and Tier 5 (Specialty Tier) drugs require a 25% coinsurance. These coinsurance rates remain the same whether you use preferred or standard pharmacies and mail-order services.
Additional Benefits
The Community Blue Medicare HMO Signature (HMO) plan offers robust core medical coverage featuring no copay for primary care visits and a $30 copay for specialist consultations. Inpatient hospital stays require a $195 daily copay for the first five days, while outpatient hospital visits carry a $245 copay, with no coinsurance required for either service. Emergency room visits have a $130 copay, which is waived if you are admitted to the hospital within three days. This plan also provides generous supplemental benefits, including preventive and comprehensive dental services up to a $3,000 annual limit with no copay for most covered care. Vision benefits feature a $30 copay for routine eye exams and up to $400 annually for eyewear with no copay, while prescription hearing aids are covered with copays between $699 and $999. Additionally, members can access over-the-counter items with no copay up to a $40 maximum benefit every three months.
Inpatient Hospital See details
Community Blue Medicare HMO Signature (HMO) covers inpatient hospital stays with no coinsurance, requiring a $195 daily copay for days 1 to 5 of acute stays and a $425 daily copay for days 1 to 3 of psychiatric stays, followed by no copay for remaining days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Community Blue Medicare HMO Signature (HMO) covers outpatient services with no coinsurance, featuring a $245 copay for outpatient hospital and daily observation services, and a $175 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
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 a $300 copay and no coinsurance for ground and air ambulance trips. The plan also provides unlimited one-way transportation to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Community Blue Medicare HMO Signature (HMO) 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 and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $40 to $300.
Primary Care See details
Community Blue Medicare HMO Signature (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Other services like physical therapy, mental health, and telehealth feature copays ranging from $0 to $45 with no coinsurance, though chiropractic care is only partially covered because other chiropractic services are not covered.
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 routine screenings. Additional preventive services are partially covered—including memory fitness and enhanced disease management (no copay and no coinsurance), remote access technologies ($0 to $30 copay and no coinsurance), and home safety devices (no copay and 20% coinsurance)—while health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy 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 are not covered.
Hearing Services See details
Hearing services are partially covered by Community Blue Medicare HMO Signature (HMO), which offers one routine hearing exam per year with a $10 copay and no coinsurance, but does not cover fitting and evaluation exams. Prescription hearing aids are covered with no coinsurance and copays between $699 and $999 for up to two devices annually, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Community Blue Medicare HMO Signature (HMO), featuring one routine eye exam per year with a $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $400 annual maximum for contact lenses, eyeglasses, and upgrades.
Dental Services See details
Community Blue Medicare HMO Signature (HMO) provides partially covered dental services with a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $3,000 annual limit. Other diagnostic dental services, other preventive dental 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 and no coinsurance, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs carry no copay and 0% to 20% coinsurance, while covered Part B insulin requires a $35 copay and 0% 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 with no copays, though prior authorization is required for these services. Coinsurance ranges from 0% to 50% for durable medical equipment, is 20% for prosthetics and medical supplies, and ranges from 0% to 20% for diabetic equipment and supplies.
Diagnostic and Radiological Services See details
Community Blue Medicare HMO Signature (HMO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. Lab services have no copay, diagnostic tests range from a $0 to $10 copay, outpatient X-rays require a $20 copay, and therapeutic and diagnostic radiological services have minimum copays of $60 and $195, respectively.
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
Cardiac Rehabilitation Services are covered by Community Blue Medicare HMO Signature (HMO) with no copay and no coinsurance. While some services are covered, specific sub-services such as 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, requiring prior authorization and no prior three-day 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 standard Medicare-covered limit are not covered.
Other Services See details
Community Blue Medicare HMO Signature (HMO) provides partial coverage for other services, which includes over-the-counter (OTC) items with no copay and no coinsurance up to a $40 maximum benefit every three months. Acupuncture, meal benefits, and other services under this category are not covered.
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