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Together Blue Medicare HMO Signature (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Together 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 Together Blue Medicare HMO Signature (HMO) in 2026, please refer to our full plan details page.
Together Blue Medicare HMO Signature (HMO) is a HMO plan offered by Highmark Health available for enrollment in 2025 to people living in 5 County Western PA. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Together 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 Together 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 Together 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 $38.00. 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 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 $4900.00 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 Together Blue Medicare HMO Signature (HMO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service. If you fill these generic prescriptions at a standard pharmacy, Tier 1 drugs require a $7 copay for a one-month supply, and Tier 2 drugs require 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 carry a 20% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance. These coinsurance rates apply regardless of whether you use a preferred or standard pharmacy, with specialty tier drugs limited to a one-month supply.
Additional Benefits
The Together Blue Medicare HMO Signature (HMO) plan offers affordable medical coverage with no copay for primary care visits, home health services, and partial hospitalization. Specialists, physical therapy, and routine eye or hearing exams are highly accessible with a low $10 copay and no coinsurance. For more intensive care, inpatient hospital stays require a $200 copay per stay, while emergency room visits carry a $130 copay that is waived if you are admitted. This plan also features robust dental coverage with no copay up to a $3,000 annual maximum, alongside a $350 yearly allowance for eyewear with no copay or deductible. Additionally, members receive an over-the-counter benefit of $195 every three months and unlimited transportation to approved health locations with no copay. Other services like diagnostic lab work and home infusions are covered with no copay, though durable medical equipment and dialysis require coinsurance.
Inpatient Hospital See details
Together Blue Medicare HMO Signature (HMO) covers inpatient acute hospital stays with a $200 copay per stay, no coinsurance, and unlimited additional days at no copay, though prior authorization is required. Inpatient psychiatric stays are also covered with no coinsurance and require prior authorization, with a $325 daily copay for days 1 through 3 and no copay for days 4 through 90, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Together Blue Medicare HMO Signature (HMO) covers outpatient services with no coinsurance, including outpatient hospital and daily observation services for a $155 copay, and ambulatory surgical center services for a $95 copay. Outpatient substance abuse services require a $30 copay per individual or group session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Together Blue Medicare HMO Signature (HMO) covers partial hospitalization services with no copay and no coinsurance. This benefit ensures you can access structured psychiatric care without any out-of-pocket costs.
Ambulance and Transportation Services See details
Together Blue Medicare HMO Signature (HMO) covers ambulance and transportation services, though transportation is only partially covered as trips to any health-related location are excluded. Medicare-covered ground and air ambulance services require a $215 copay with no coinsurance, while unlimited one-way transportation to plan-approved health-related locations is offered with no copay and no coinsurance.
Emergency Services See details
Together Blue Medicare HMO Signature (HMO) covers emergency services with a $130 copay (waived if admitted to the hospital within 3 days) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency services are also covered with no coinsurance, requiring a $130 copay for emergency care, a $40 copay for urgent care, and a $215 copay for emergency transportation.
Primary Care See details
Together Blue Medicare HMO Signature (HMO) features primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and podiatry require a $10 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services carry a $30 copay with no coinsurance, and chiropractic care is partially covered with a $15 copay and no coinsurance for up to 4 routine visits per year.
Preventive Services See details
Together Blue Medicare HMO Signature (HMO) features partially covered preventive services, offering annual physicals, kidney disease education, and routine screenings with no copay and no coinsurance. Additional benefits include memory fitness and disease management, remote access technologies with a $0 to $10 copay and no coinsurance, and home safety modifications with a 20% coinsurance and no copay. Sub-services like 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 benefits, palliative care, in-home support, caregiver support, tobacco cessation, telemonitoring, and counseling are not covered.
Hearing Services See details
Together Blue Medicare HMO Signature (HMO) partially covers hearing services, providing one annual routine hearing exam for a $10 copay and no coinsurance, and up to two prescription hearing aids per year with a $699 to $999 copay and no coinsurance. Hearing aid fittings and evaluations, 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 Together Blue Medicare HMO Signature (HMO), as other eye exam services are not covered. Covered benefits feature one annual routine eye exam for a $10 copay and no coinsurance, and eyewear with no copay, no coinsurance, and a $350 yearly limit for contacts, frames, lenses, and upgrades, with no deductibles for either service.
Dental Services See details
Together Blue Medicare HMO Signature (HMO) provides partially covered dental services, offering Medicare-covered dental care for a $10 copay and no coinsurance, and other covered dental services with no copay and no coinsurance up to a $3,000 annual maximum. While preventive and restorative care are covered, orthodontics, implants, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Together Blue Medicare HMO Signature (HMO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Together Blue Medicare HMO Signature (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Together Blue Medicare HMO Signature (HMO) covers medical equipment with no copays, though coinsurance ranges from 0% (no coinsurance) up to 50% depending on the specific item. Prior authorization is required for durable medical equipment, prosthetics, and diabetic supplies.
Diagnostic and Radiological Services See details
Together Blue Medicare HMO Signature (HMO) partially covers diagnostic and radiological services with no coinsurance, although prior authorization is required. Lab services have no copay, diagnostic procedures carry a $0 to $10 copay, diagnostic radiological services require a minimum $95 copay, and therapeutic radiological services require a minimum $60 copay, while outpatient X-ray services are not covered.
Home Health Services See details
Together Blue Medicare HMO Signature (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Together Blue Medicare HMO Signature (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Together Blue Medicare HMO Signature (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Patients pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Together Blue Medicare HMO Signature (HMO) partially covers other services, offering an over-the-counter (OTC) benefit with no copay and no coinsurance up to $195 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone coverage are not covered under this plan.
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