Community Blue Medicare HMO Plans
Selecting the right Medicare Advantage plan is crucial for your healthcare needs. Community Blue Medicare HMO offers a network-focused plan with capped costs and comprehensive coverage, including prescription drug options.
This article provides a clear breakdown of the plan’s offerings, eligibility, and benefits, arming you with the information needed to make an informed choice.
Key Takeaways
- Community Blue Medicare HMO offers a comprehensive network and coverage, including Part A, Part B, and Part D benefits, with $0 copays for preferred generic drugs and added support for finding suitable doctors and managing health information.
- Eligibility for Community Blue Medicare HMO requires entitlement to Medicare Part A and B, aged between 50 and 80, with potential disqualifying conditions such as ESRD or ALS; it features a yearly deductible of $1,000 and varying copays for services like hospital admissions.
- The plan provides extensive healthcare service coverage for preventive care, diagnostics, hospital stays, mental health services, and more, with copays differing based on the service; there are multiple customer service channels for member support.
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Understanding Community Blue Medicare HMO
Members of Medicare Advantage plan, also known as Medicare HMOs, are required to utilize providers within a designated network.
The Community Blue Medicare HMO follows this model and stands out with its high-value network of chosen providers and support services that help members find doctors and coordinate health information.
Notable features of this plan include a robust service model that assists members in scheduling medical appointments and managing health information.
A comprehensive benefits package is also part of the plan, covering fundamental costs and providing:
- healthcare services
- medical supplies
- dental services
- vision services
- hearing services
- preventive services
What is a Medicare HMO?
A Medicare Health Maintenance Organization (HMO) is a type of health plan approved by Medicare. Provided by private companies, these plans are designed to offer coverage for most of the Part A and Part B benefits, as opposed to Original Medicare. However, these plans have network restrictions.
Coverage is limited to care received from in-network providers and facilities, with emergencies or urgent care situations being the exceptions. Remember that doctors have the freedom to leave the HMO’s network at any time, even during the plan year.
Key Features of Community Blue Medicare HMO
Community Blue Medicare HMO sets itself apart through its array of features. These include:
- A high-value network of select providers
- An enhanced service model that aids members in locating suitable doctors
- Comprehensive coverage inclusive of Medicare Part D drug coverage
- Preventive health services at no extra cost
In addition to basic coverage, the plan also offers supplementary benefits like dental, vision, hearing, and fitness programs.
Who Is Eligible for Community Blue Medicare HMO?
To qualify, you must:
- Be entitled to Medicare Part A benefits
- Be enrolled in Medicare Part B
- Fall between the ages of 50 and 80
- Be a US citizen or meet the same eligibility criteria if you are not a US citizen
However, certain health conditions such as end-stage renal disease (ESRD), ALS, heart disease, cancer, asthma, and high blood pressure could affect your eligibility.
Prescription Drug Coverage in Community Blue Medicare HMO
Prescription drug coverage is a major benefit of the Community Blue Medicare HMO. The plan manages changes in prescription drug coverage on an annual basis. So, adjustments will be made to the plan’s costs and coverage for the upcoming plan year.
The formulary of Community Blue Medicare HMO includes:
- Generic drugs, details of which can be found on the Highmark Medicare website
- Specialty tier drugs, priced between approximately $37 and $45
- Non-preferred drugs, consisting of higher-cost brand-name and generic drugs
The pricing model for specialty tier and non-preferred drugs generally exceeds that of the preferred brand drugs.
$0.00 Copay for Preferred Generic Drugs
A significant advantage of the Community Blue Medicare HMO is the $0.00 copay for preferred generic drugs. This means that members aren’t required to make any out-of-pocket payments for those medications.
Be aware that under certain circumstances, like when members are in the coverage gap, the $0 copay for preferred generic drugs might not apply.
In these situations, members may need to pay a higher amount out-of-pocket.
Specialty Tier and Non-Preferred Drugs
Specialty tier drugs in Community Blue Medicare HMO are categorized as Tier 5 drugs.
These are typically used to treat complex or rare conditions. These drugs typically have a coinsurance cap for a one-month’s supply of specific medications, such as insulin. For other drugs in this tier, the cost-sharing varies, but there is no copay.
Non-preferred drugs typically fall under Tiers 4 and 5. These often include brand-name medications with higher costs compared to preferred drugs. The pricing for these non-preferred drugs is based on a standard cost, with a typical copay of 33% of the drug’s cost for Tier 4 drugs.
Plan Deductible and Out-of-Pocket Maximums
Regarding financial commitments, members have a yearly deductible of $1,000 in the Community Blue Medicare HMO. This deductible applies to all services, save for emergency services. As for the out-of-pocket maximum, the plan imposes a $295 copay per hospital admission.
Bear in mind that some services aren’t included in the out-of-pocket maximum when making healthcare decisions.
Health Care Services Covered by Community Blue Medicare HMO
Community Blue Medicare HMO covers a broad spectrum of healthcare services, including:
- Diagnostic tests and procedures
- Mental health services
- Nursing home services
- Home health services
Such extensive coverage allows you to access the care you need without worrying about high costs, even if you require it per day for days.
Diagnostic Tests and Procedures
The Community Blue Medicare HMO includes Medicare-covered diagnostic procedures and tests, with a copayment of $0.00.
However, it’s important to note that a referral or prior approval may be required for diagnostic tests and procedures.
You can find comprehensive information about co-payment and deductible requirements in the official document available online.
Per Stay and Per Day Costs for Hospitalization
The costs associated with hospitalization in Community Blue Medicare HMO plans are as follows:
- $295 copay per admission
- $200 copayment for acute hospital services per stay
- For the first three days of hospitalization, a $425 copay per day per admit
- From the fourth day to the ninetieth day, a $0 copay per day
Keep in mind that hospitalization costs may vary depending on the type of hospital and the severity of the health condition.
Preventive Care Services
Community Blue Medicare HMO includes a comprehensive range of preventive care services such as exams, shots, lab tests, and screenings.
These services include health checks for hepatitis C, HIV, lung cancer, mammograms, diabetes, glaucoma, and hepatitis B infection. In addition to these, routine check-ups and screenings form part of the preventive care services offered by the plan.
Notably, vaccinations are also included in the preventive care services offered by Community Blue Medicare HMO.
How to Contact Community Blue Medicare HMO
Swift and clear communication is vital when dealing with a health insurance plan. You can contact Community Blue Medicare HMO’s customer service at 1-888-XXX-XXXX, available from 8:00 a.m. to 8:00 p.m. EST, 7 days a week
. You can also find a wealth of information regarding Community Blue Medicare HMO online at https://medicare.highmark.com/resources/medicare-library/plan-documents/community-blue-medicare-hmo.html.
Customer Service Contact Information
To contact Community Blue Medicare HMO, you have the following options:
- Call 1-888-XXX-XXXX for assistance with both technical and medical inquiries.
- Send mail to their mailing address at P.O. Box 1068, Pittsburgh, PA 15230-1068.
- Multilingual assistance, including a customer service line for Spanish speakers, is also available.
Online Resources and Tools
Community Blue Medicare HMO offers the following features for its members, including the Blue Medicare HMO Signature plan:
- An online portal to manage their accounts effectively
- Access to health records through Medicare’s Blue Button, which consolidates all Medicare claims records in a single location
- Mobile applications for secure communication with the care management team and special discounts
In-Person Assistance
If you prefer in-person interactions, Community Blue Medicare HMO aids at their physical location at P.O. Box 1068, Pittsburgh, PA 15230-1068.
Operating hours for in-person assistance are from 8:00 a.m. to 8:00 p.m., Eastern Time, Monday through Sunday.
In-person assistance includes services like:
- Community support programs
- Food programs
- Transportation services
- Financial assistance
- Medical care
- Referrals to mental health facilities and programs
Summary
In a nutshell, Community Blue Medicare HMO stands out as a comprehensive Medicare Advantage plan, with a distinct focus on providing a wide range of healthcare services and prescription drug coverage.
From a $0.00 copay for preferred generic drugs to coverage for mental health services, hospitalization costs, and preventive care, the plan offers immense value, making it an attractive choice for those eligible.
Yet, as with any health insurance plan, it’s crucial to fully understand the coverage, costs, and restrictions associated with the plan. With this information at your fingertips, you’ll be in a better position to make an informed decision that aligns with your healthcare needs and financial situation.
Frequently Asked Questions
→ What is the difference between HMO and Medicare HMO?
The main difference between an HMO plan and a Medicare HMO plan is that with an HMO plan you have a primary care physician (PCP) who coordinates your care, while a Medicare Supplement plan allows you to see any doctor that accepts Original Medicare.
→ Is Highmark Community Blue an advantage plan?
Yes, Highmark Community Blue is a Medicare Advantage Preferred Provider Organization (PPO) plan offering access to a national network of participating providers, including coverage for various healthcare needs.
→ What are the key features of Community Blue Medicare HMO?
The key features of Community Blue Medicare HMO include a high-value network of chosen providers, enhanced support services for locating doctors and coordinating health information, and a comprehensive benefits package.
These features make it a robust option for Medicare coverage.
→ What is the prescription drug coverage in Community Blue Medicare HMO?
Community Blue Medicare HMO offers prescription drug coverage, including a $0.00 copay for preferred generic drugs and different costs for specialty tier and non-preferred drugs.
→ How can I contact Community Blue Medicare HMO for assistance?
You can contact Community Blue Medicare HMO through their customer service number, online portal, mobile applications, or in-person at their physical location. It provides various channels for assistance to cater to different preferences.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.