Security Blue HMO-POS Basic (HMO-POS) Medicare Advantage Plan H3957-043-2 • 2027 • Potter County, PA
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $5900.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Potter County, PA
- Local Enrollment
- 0 beneficiaries in Potter County
Security Blue HMO-POS Basic (HMO-POS) Introduction
Security Blue HMO-POS Basic is a Medicare Advantage HMO-POS plan offered by Highmark Blue Cross Blue Shield or Highmark Blue Shield. It uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes without prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $0.00 medical deductible, and $5900.00 in-network maximum out-of-pocket. CMS Plan ID H3957-043-2 identifies this plan.
You must live in Potter County, Pennsylvania to enroll in this plan. CMS reports 0 beneficiaries enrolled in this plan in Potter County. For assistance with this plan, new members can call (866)670-5844 (TTY 711).
Compare Similar Plans in Potter County
Compare this plan with the two most-enrolled HMO-POS plans available in Potter County, Pennsylvania. Enrollment is based on CMS local enrollment data.
| Plan Detail | Security Blue HMO-POS Basic | Aetna Medicare Advantra Signature | AARP Medicare Advantage from UHC PA-0002 |
|---|---|---|---|
| CMS Plan ID | H3957-043-2 |
H3959-037-0 |
H5253-146-0 |
| Local Enrollment | 0 | 119 | 26 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $5,900.00 | $7,500.00 | $7,150.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $30 copay | $35 copay | $0-$50 copay |
| Part D Deductible | Not Applicable | $400.00 | $685.00 |
| CMS Star Rating | 4.5 | 3.5 | 4.0 |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Want to explore more options? Browse all Medicare Advantage plans in Potter County, or compare Medicare Advantage plans across Pennsylvania, including premiums, out-of-pocket costs, CMS ratings, and enrollment.
Plan Benefits
Security Blue HMO-POS Basic has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H3957-043-2.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H3957-043-2 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Specialist
- In-network: $30 copay
Out-of-network: $30 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Telehealth benefit
- In-network: $0-$45 copay
- Routine chiropractic
- In-network: $15 copay
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- Not covered
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $100 copay
Out-of-network: $175 copay - Lab services
- In-network: $0-$20 copay
Out-of-network: $30 copay - Outpatient x-rays
- In-network: $25 copay
Out-of-network: $40 copay - Diagnostic tests and procedures
- In-network: $0-$20 copay
Out-of-network: $30 copay
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $45 copay
- Inpatient hospital care
- In-network:
Tier 1
$340 per stay
Out-of-network:
$390 per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100 - Ground ambulance
- In-network: $280 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $30 copay
Out-of-network: $45 copay - Outpatient group therapy
- In-network: $30 copay
Out-of-network: $45 copay - Inpatient psychiatric hospital care
- In-network:
Tier 1
$340 per stay
Out-of-network:
$390 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $30 copay
Out-of-network: $45 copay - Occupational therapy
- In-network: $30 copay
Out-of-network: $45 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: 0%-20% coinsurance
- Durable medical equipment
- In-network: 20% coinsurance
- Prosthetics
- In-network: 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- Not covered
- Endodontics
- Not covered
- Restorative services
- Not covered
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- Not covered
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0-$40 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- In-network: $0-$40 copay
- Upgrades
- In-network: $0 copay
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- Not covered
- Prescription hearing aids
- In-network: $599-$899 copay
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- In-network: 20% coinsurance
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.
CMS 5-Star Performance Ratings (Contract ID: H3957)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Highmark Blue Cross Blue Shield or Highmark Blue Shield
- Website
- Highmark Blue Cross Blue Shield or Highmark Blue Shield Plan Page
- Providers
- Highmark Blue Cross Blue Shield or Highmark Blue Shield Providers Page
- Formulary
- Highmark Blue Cross Blue Shield or Highmark Blue Shield Formulary Page
- Pharmacy
- Highmark Blue Cross Blue Shield or Highmark Blue Shield Pharmacy Page
- New Member Health Plan Help
- (866)670-5844
- New Member Health Plan TTY
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Advantage Plan Availability
Security Blue HMO-POS Basic is available to eligible Medicare beneficiaries residing in Potter County, Pennsylvania, including communities such as Shinglehouse, Coudersport, Galeton, Ulysses, and other areas throughout the county. Enrollment eligibility is based on county of residence, not city.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Highmark Blue Cross Blue Shield or Highmark Blue Shield (official source) | http://medicare.highmark.com | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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