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Verified against CMS.gov · on July 2026 Plan ID: H3957-042 Cross-check on Medicare.gov →

Community Blue Medicare HMO Signature (HMO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00 Annual Deductible
970 Drugs Covered
1 States Served

Top Covered Drugs

Most popular medications covered by this plan, ordered by national search frequency. Click any drug to see exact copay, restrictions, and alternatives.

# Drug Name Type Tier 30-Day Copay
1 Diltiazem Hydrochloride Brand Tier 2 $0.00 Details
2 Levothyroxine Sodium levothyroxine sodium Brand Tier 1 $0.00 Details
3 Loxapine Brand Tier 2 $0.00 Details
4 bexarotene Brand Tier 5 0.3% coinsurance Details
5 Erlotinib Brand Tier 5 0.3% coinsurance Details
6 Verzenio abemaciclib Brand Tier 5 0.3% coinsurance Details
7 Haloperidol Brand Tier 2 $0.00 Details
8 Phenobarbital Brand Tier 2 $0.00 Details
9 Lenalidomide Brand Tier 5 0.3% coinsurance Details
10 Sodium Chloride Brand Tier 2 $0.00 Details
11 Ibrance palbociclib Brand Tier 5 0.3% coinsurance Details
12 ISENTRESS RALTEGRAVIR Brand Tier 3 0.2% coinsurance Details
13 VAQTA hepatitis A vaccine, inactivated Brand Tier 3 0.2% coinsurance Details
14 Emtricitabine, Rilpivirine, Tenofovir Disoproxil Fumarate Brand Tier 5 0.3% coinsurance Details
15 amiloride hydrochloride Brand Tier 2 $0.00 Details
16 Augtyro repotrectinib Brand Tier 5 0.3% coinsurance Details
17 ENTRESTO Sacubitril and Valsartan Brand Tier 3 0.2% coinsurance Details
18 Nefazodone Hydrochloride Brand Tier 4 0.3% coinsurance Details
19 Daurismo glasdegib Brand Tier 5 0.3% coinsurance Details
20 Ibrance palbociclib Brand Tier 5 0.3% coinsurance Details

Showing 20 of 970 covered drugs.

Compare this plan against others for your medications Enter your drugs and ZIP to see personalized out-of-pocket costs.
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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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