Community Blue Medicare HMO Distinct (HMO)
The Community Blue Medicare HMO Distinct (HMO) is a 2026 HMO Medicare Advantage plan from Highmark Blue Cross Blue Shield or Highmark Blue Shield with a $27.00/mo premium and a 4.5-star CMS rating. It may include allowances for vision and otc / flex allowance. It's available in 1 county across 1 state.
Reviewed by the Medicare Advocates team · 2026 plan year · sourced from CMS data
Offered in 1 county across 1 state
- Monthly premium$27.00
- Overall star rating4.5 / 5
- In-network max out-of-pocket$6,250
- Vision$400
- OTC / Flex allowance$300
2026 plan-year figures (premium, star rating, MOOP) from the CMS Landscape file; allowance amounts from CMS PBP data. Amounts vary by plan; not all plans offer all benefits.
What the Community Blue Medicare HMO Distinct (HMO) plan may include
- Vision: up to $400 per year in plan allowance (2026).
- OTC / Flex allowance: up to $300 per year in plan allowance (2026).
Costs & coverage detail
Annual Part D drug deductible: $615 (2026).
Doctor visits
- Specialist visit$20 copay
Emergency & urgent care
- Emergency room$130 copay
- Urgent care$40 copay
Tests, labs & imaging
- Lab services$0–$10 copay
- Diagnostic tests & procedures$0–$10 copay
- X-rays$10 copay
- Diagnostic radiology (CT/MRI/PET)$200 copay
Outpatient hospital & surgery
- Outpatient hospital services$245 copay
- Ambulatory surgical center$195 copay
- Outpatient substance abuse (individual)$45 copay
Medical equipment & supplies
- Durable medical equipment (DME)0–50% coinsurance
Ambulance
- Ground ambulance$345 copay
Vision
- Routine eye exam$20 copay
Hearing
- Routine hearing exam$20 copay
- Hearing aids$699–$999 copay
Hospital stays
- Skilled nursing facility (SNF)$0/day, days 1–20; $218/day, days 21–100
In-network, Medicare-covered cost sharing for the 2026 plan year (CMS PBP data). Costs vary by service and setting; see the Summary of Benefits for full detail.
Extra benefit allowances
- Eyewear allowance$400 per year
- Over-the-counter (OTC) allowance$75 per quarter
Prescription drug costs
Annual Part D drug deductible: $615.
| Tier | Preferred retail | Standard retail | Mail (90-day) |
|---|---|---|---|
| Tier 1 · Preferred Generic | $0 | $7 | $0 |
| Tier 2 · Generic | $0 | $15 | $0 |
| Tier 3 · Preferred Brand | 20% | 20% | 20% |
| Tier 4 · Non-Preferred Drug | 25% | 25% | 25% |
| Tier 5 · Specialty Tier | 25% | 25% | — |
30-day supply cost share for the 2026 plan year, in-network (mail column shows 90-day). Amounts shown are before any deductible applies and vary by drug.
Preventive services
This plan covers $0 for all preventive services covered under Original Medicare when you use an in-network provider — including annual wellness visits, recommended screenings, and vaccines.
Common questions
- What is the Community Blue Medicare HMO Distinct (HMO) plan?
- It is a Medicare Advantage plan (CMS plan ID H3957-049-002) offered by Highmark Blue Cross Blue Shield or Highmark Blue Shield for the 2026 plan year. Medicare Advantage plans bundle your Part A and Part B coverage, and most include extra benefits Original Medicare does not.
- What extra benefits could this plan include?
- Depending on the plan, supplemental benefits may include allowances toward vision, otc / flex allowance. Amounts shown are for the 2026 plan year and vary by plan and area. A licensed agent can confirm what is available to you.
- Where is this plan available?
- For 2026, this plan is offered in 1 county across 1 state. Availability and benefits depend on your specific ZIP code.
- How do I enroll or compare plans?
- Call to speak with a licensed insurance agent who can review this plan alongside the other options in your area at no cost. There is no obligation to enroll, and enrollment may be limited to certain times of year unless you qualify for a Special Enrollment Period.
Counties served
Pennsylvania (1 county)
Lancaster
Plan documents
Official 2026 documents for this plan:
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