Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026

Capital Blue Cross Premier, 2027

H3962Contract001Plan

HMO · 21 counties in Pennsylvania

Run by Keystone Health Plan Central, Inc. (contract H3962), sold as Capital Blue Cross, owned by CAPITAL BLUE CROSS

Renews for 2027

2026 star rating, contract H3962: 4.5 of 5

Capital Blue Cross Premier (H3962-001) costs $90 a month in 2027, up $4 from 2026, with an in-network out-of-pocket limit of $5,000.

What changes from 2026 to 2027?

The changed lines are marked and come first. In-network amounts; members keep paying the Part B premium unless the plan reduces it.
What you pay or get	2026	2027	Change
Monthly premium	$86	$90	up $4
Drug deductible	$100	$350	up $250
Hospital stay, in network	$125 a day for days 1–4, then $0 a day for days 5–90	$125 a day for days 1–5, then $0 a day for days 6–90	up $125for a 5-day stay
Ground ambulance, in network	$150 copay	$125 copay	down $25
Eyewear, yearly limit	$200 a year	$125 a year	down $75
Over-the-counter items, yearly	$360 a year	$180 a year	down $180
Drug tier 3, preferred brand	$47	19% of the cost	changed
Drug tier 4, non-preferred drug	$100	20% of the cost	changed
Drug tier 5, specialty tier	31% of the cost	29% of the cost	down 2 points
12 lines do not change
In-network out-of-pocket limit	$5,000	$5,000	no change
Part B premium reduction, monthly	none	none	no change
Primary care visit	$0 copay	$0 copay	no change
Specialist visit	$15 copay	$15 copay	no change
Emergency room	$130 copay	$130 copay	no change
Medical deductible, in network	none	none	no change
Skilled nursing facility, in network	$10 a day for days 1–20, then $218 a day for days 21–100	$10 a day for days 1–20, then $218 a day for days 21–100	no change
Comprehensive dental, yearly limit	not offered	not offered	no change
Hearing aids, yearly limit for both ears	not offered	not offered	no change
Counties served	21	21	no change
Drug tier 1, preferred generic	$10	$10	no change
Drug tier 2, generic	$15	$15	no change

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.

What will prescriptions cost?

Your share for a 30-day supply at a retail pharmacy, as filed with CMS; tiers whose share changes are marked. The plan charges less at its preferred pharmacies
Tier	What the tier holds	2026, standard pharmacy	2027, standard pharmacy	2027, preferred pharmacy
Tier 1	Preferred Generic	$10	$10	$0
Tier 2	Generic	$15	$15	$0
Tier 3	Preferred Brand	$47	19% of the cost	19% of the cost
Tier 4	Non-Preferred Drug	$100	20% of the cost	20% of the cost
Tier 5	Specialty Tier	31% of the cost	29% of the cost	29% of the cost

Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.

How does it compare with plans sold where it is?

In the counties it serves, 100 plans open to everyone are sold for 2027, this one included. Against the others, 7 plans have a lower out-of-pocket limit, 1 the same, 91 a higher one. On the premium, 90 plans have a lower premium, 1 the same, 8 a higher one.

Out-of-pocket limits of the 100 plans open to everyone

$0 to under $2,0000 plans

$2,000 to under $4,0001 plan

$4,000 to under $6,000 (this plan)17 plans

$6,000 to under $8,00052 plans

$8,000 to $10,00030 plans

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Where is it sold, and what does it cost there?

The premium and the out-of-pocket limit are the same in all 21 counties: $90 a month and $5,000.

Pennsylvania

Adams Berks Centre Columbia Cumberland Dauphin Franklin Fulton Juniata Lancaster Lebanon Lehigh Mifflin Montour Northampton Northumberland Perry Schuylkill Snyder Union York

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Who runs this plan?

Plan ID: H3962-001
Legal name of the contract: Keystone Health Plan Central, Inc.
Sold as: Capital Blue Cross
Parent company: CAPITAL BLUE CROSS
Plan type: HMO
2026 star rating of the contract: 4.5 of 5 overall; health plan 4 of 5, drug plan 4 of 5
Members, September 2026: 1,453
Plan website, as filed with CMS: www.capitalbluemedicare.com

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.

What else should you check?

Other 2027 plans in Lehigh, PAWhere most of its members live; premiums and limits side by side
Every Capital Blue Cross plan for 2027Its contracts, counties and plans that end
The other 2 plans of contract H3962Same company, same contract
Is your prescription covered?Coverage share and tier for 2,259 drugs

Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.