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

Capital Blue Cross Essential, 2027

H3962Contract022Plan

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 Essential (H3962-022) costs $0 a month in 2027, the same as in 2026, with an in-network out-of-pocket limit of $5,550 to $7,100 depending on the county ($6,000 in 2026).

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. The plan files its benefits in parts for different counties, so lines marked ◆ show the most generous part of its area and some counties get less: the plan's Evidence of Coverage gives your county's amounts.
What you pay or get	2026	2027	Change
In-network out-of-pocket limit, by county	$6,000	$5,550 to $7,100	up $1,100 at the top
Drug deductible	$375	$700	up $325
Specialist visit (best in its area)	$20 copay	$25 copay	up $5
Hospital stay, in network (best in its area)	$135 a day for days 1–4, then $0 a day for days 5–90	$260 a day for days 1–5, then $0 a day for days 6–90	up $760for a 5-day stay
Skilled nursing facility, in network (best in its area)	$10 a day for days 1–20, then $218 a day for days 21–100	$10 a day for days 1–20, then $221 a day for days 21–100	up $30for a 30-day stay
Ground ambulance, in network (best in its area)	$195 copay	$120 copay	down $75
Eyewear, yearly limit (best in its area)	$200 a year	$125 a year	down $75
Over-the-counter items, yearly (best in its area)	$180 a year	$120 a year	down $60
Drug tier 4, non-preferred drug	40% of the cost	20% of the cost	down 20 points
Drug tier 5, specialty tier	28% of the cost	25% of the cost	down 3 points
11 lines do not change
Monthly premium	$0	$0	no change
Part B premium reduction, monthly (best in its area)	none	none	no change
Primary care visit (best in its area)	$0 copay	$0 copay	no change
Emergency room (best in its area)	$130 copay	$130 copay	no change
Medical deductible, in network (best in its area)	none	none	no change
Comprehensive dental, yearly limit (best in its area)	not offered	not offered	no change
Hearing aids, yearly limit for both ears (best in its area)	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
Drug tier 3, preferred brand	19% of the cost	19% of the cost	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	19% of the cost	19% of the cost	19% of the cost
Tier 4	Non-Preferred Drug	40% of the cost	20% of the cost	20% of the cost
Tier 5	Specialty Tier	28% of the cost	25% of the cost	25% 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, 13 plans have a lower out-of-pocket limit, 86 a higher one. On the premium, 61 the same, 38 a higher one.

Its limit differs by county ($5,550 to $7,100); the chart marks its lowest.

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?

21 counties, grouped by what the plan costs there
Monthly premium	Out-of-pocket limit	Where
$0	$5,550	Adams (PA), Franklin (PA), York (PA)
$0	$6,800	Centre (PA), Dauphin (PA), Juniata (PA), Mifflin (PA), Perry (PA)
$0	$7,100	Berks (PA), Columbia (PA), Cumberland (PA), Fulton (PA), Lancaster (PA), Lebanon (PA), Lehigh (PA), Montour (PA), Northampton (PA), Northumberland (PA), Schuylkill (PA), Snyder (PA), Union (PA)

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: H3962-022
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: 5,501
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 Berks, 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.