Security Blue HMO-POS Basic (HMO-POS) Medicare Advantage Plan H3957-043-2 • 2026 • Jefferson County, PA

Security Blue HMO-POS Basic Overview

Plan Details for Security Blue HMO-POS Basic

Security Blue HMO-POS Basic is a Medicare Advantage HMO-POS plan that provides Medicare Part A and Part B coverage through a network of participating providers, with limited coverage available for out-of-network services in certain situations. The monthly premium is $0.00, and costs are generally lower when services are received from in-network providers.

Primary care visits have a $0 copay | Out-of-network: $0 copay, 0% coinsurance, specialist visits come with a $30 copay | Out-of-network: $30 copay, urgent care services carry a $50 copay, and ambulance transportation is $280 copay. These costs apply toward the maximum out-of-pocket (MOOP) limit of $5900.00. Once this limit is reached, in-network services are fully covered for the remainder of the year.

This plan is listed by CMS under Plan ID H3957-043-2. Cost-sharing details are provided below.

Out-of-Pocket Costs

Cost-sharing for Security Blue HMO-POS Basic includes out-of-pocket expenses for covered healthcare services. The table below provides a summary of typical in-network out-of-pocket costs for plan H3957-043-2.

Certain preventive services are covered 100% by Security Blue HMO-POS Basic as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

Medicare Plan Star Ratings

CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.