Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H3957-049-001

Community Blue Medicare HMO Distinct (HMO) · Highmark Blue Cross Blue Shield or Highmark Blue Shield · Lackawanna, Luzerne, Wyoming, PA

Compact plan code: H3957049001

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Community Blue Medicare HMO Distinct (HMO)

H3957-049-001 Lackawanna, Luzerne, Wyoming, PA HMO
Open in quick lookup
01

In-network

Inpatient hospital

Per admission $295 per stay
Plan-listed inpatient copay $295
02

Emergency transport

Ambulance

Ground · in-network$345 copay
Air · in-network$345 copay
03

Emergency services

Emergency room

$130 copay

Waived if admitted

04

Medical maximum

Maximum out-of-pocket

In-network$6,250
Combined in + outNot reported
05

Skilled care at home

Home health

In-networkNo cost share reported
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premium$27 / month
Consolidated C + D$27 / month

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release. Quick-reference values should be confirmed in current official plan documents.

PBP benefits ↗ Landscape data ↗

Same CMS contract

H3957-031-000 Security Blue HMO-POS ValueRx (HMO-POS) Southwestern PA · HMOPOS H3957-042-001 Community Blue Medicare HMO Signature (HMO) Lackawanna, Luzerne, Wyoming · HMO H3957-042-002 Community Blue Medicare HMO Signature (HMO) Lancaster, Lebanon · HMO H3957-042-004 Community Blue Medicare HMO Signature (HMO) Berks, Lehigh, Williamsport Metro · HMO H3957-042-005 Community Blue Medicare HMO Signature (HMO) Eastern PA Rural Counties Group 1 · HMO H3957-042-006 Community Blue Medicare HMO Signature (HMO) Eastern PA Rural Counties Group 2 · HMO H3957-042-007 Community Blue Medicare HMO Signature (HMO) Cumberland, Dauphin, Perry, York · HMO H3957-043-001 Security Blue HMO-POS Basic (HMO-POS) Southwest PA · HMOPOS

About this code

What H3957-049-001 identifies

H3957-049-001 is a Contract Year 2026 Medicare plan segment code. The compact form H3957049001 refers to the same normalized contract, plan, and segment shown on this page.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.