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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 2025, 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 5 out of 5 stars in 2025.
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 $37.00. 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 $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 has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a $0 copay for preferred generic drugs at preferred pharmacies. For standard generic drugs, you will pay 18% coinsurance, and 50% coinsurance for preferred brand drugs. The coinsurance for non-preferred drugs is 33%.
Additional Benefits
The Together Blue Medicare HMO Signature (HMO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, and outpatient services, including emergency services, have copays. Primary care and preventive services are covered, as are hearing, vision, and dental services, with specific copays and annual maximums for some services. The plan also covers ambulance services, some home health services with no copay, and skilled nursing facility stays with a copay after the first 20 days. Additional benefits include coverage for medical equipment, diagnostic and radiological services, and home infusion services. However, some services like cardiac rehabilitation, additional hours of care, and certain "Other Services" are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you will pay a $200 copay per stay for Medicare-covered stays, and there is no copay for additional days. For Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-3, and no copay for days 4-90.
Outpatient Services See details
Outpatient Services for the Together Blue Medicare HMO Signature (HMO) plan includes coverage for all outpatient hospital services, observation services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $155 copay, while ambulatory surgical center services have a $95 copay. Individual and group sessions for outpatient substance abuse have a copay between $30 and $30.
Partial Hospitalization See details
Partial Hospitalization is covered by the Together Blue Medicare HMO Signature (HMO) plan. There is no information available about the cost of these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Together Blue Medicare HMO Signature (HMO) plan. This includes both Ground and Air Ambulance Services, each with a copay of $215.00 and no coinsurance. Transportation Services to a Plan Approved Health-related Location are covered, and Transportation Services to Any Health-related Location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage have a copay of $125, $30, $125, and $30 respectively, and no coinsurance. Worldwide Emergency Transportation has a $215 copay, and no coinsurance.
Primary Care See details
The Together Blue Medicare HMO Signature (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy, physician specialist services, mental health specialty services with a $30 copay for individual and group sessions, podiatry services, psychiatric services with a $30 copay for individual and group sessions, physical therapy and speech-language pathology services, additional telehealth benefits with a $0-$30 copay, and opioid treatment program services with a $30 copay. Routine chiropractic care is limited to 4 visits per year.
Preventive Services See details
Preventive services, including Medicare-covered services, annual physical exams, and other preventive services are covered. Additional preventive services may have a coinsurance, and home and bathroom safety devices and modifications have a 20% coinsurance. Some services such as Health Education, In-Home Safety Assessment, and Counseling Services are not covered.
Hearing Services See details
Hearing services include routine hearing exams, covered once per year, and prescription hearing aids, covered up to two times per year with a copay between $699 and $999. Fitting/evaluation for hearing aids, inner ear prescription hearing aids, outer ear prescription hearing aids, over the ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
The Together Blue Medicare HMO Signature (HMO) plan covers vision services, including routine eye exams once per year. The plan also covers eyewear with a combined maximum benefit of $350 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Together Blue Medicare HMO Signature (HMO) plan covers dental services with a maximum benefit of $3,000 per year. Oral exams, dental x-rays, cleaning, and fluoride treatments are covered, with limitations on the number of visits and periodicity, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. The plan has a coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the Together Blue Medicare HMO Signature (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, while Diabetic Equipment has varying coinsurance costs depending on the specific service. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
For Together Blue Medicare HMO Signature (HMO), Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $95, while Therapeutic Radiological Services have a copay of at most $60, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Together Blue Medicare HMO Signature (HMO) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not in practice. 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 the Together Blue Medicare HMO Signature (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the "Other Services" benefit, acupuncture, meal benefit, 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. Over-the-counter (OTC) items are covered.
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