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Community Blue Medicare PPO Signature (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community Blue Medicare PPO Signature (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Community Blue Medicare PPO Signature (PPO) in 2026, please refer to our full plan details page.
Community Blue Medicare PPO Signature (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2025 to people living in Central and Northeastern, PA. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Community Blue Medicare PPO Signature (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Community Blue Medicare PPO Signature (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Community Blue Medicare PPO Signature (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $13.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Community Blue Medicare PPO Signature (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies or through preferred mail order. Tier 2 generic drugs are also highly affordable, costing as little as a $3 copay for a 1-month supply at a preferred pharmacy. For brand-name and specialty medications, the plan transitions from flat copays to percentage-based coinsurance. Tier 3 preferred brand drugs require a 23% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. These coinsurance rates apply across both preferred and standard pharmacies, as well as mail-order services.
Additional Benefits
The Community Blue Medicare PPO Signature (PPO) plan offers robust coverage for core medical needs, featuring no copay and no coinsurance for primary care visits and preventive screenings. Specialist visits, urgent care, and emergency services are covered with affordable, fixed copays and no coinsurance. For hospital care, members pay fixed daily copays for inpatient stays and flat copays for outpatient procedures, with no coinsurance required for either service. This plan also provides valuable supplemental benefits, including dental coverage up to a $2,500 annual limit with no copay for preventive services, and vision benefits that include no-copay eyewear up to $350 annually. Routine hearing exams and prescription hearing aids are covered with fixed copays, while home health services and the first 20 days of skilled nursing care require no copay. Additionally, members receive a quarterly allowance of up to $40 for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Community Blue Medicare PPO Signature (PPO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Acute care requires a $175 daily copay for days 1 through 5 and no copay for additional days, while psychiatric care requires a $425 daily copay for days 1 through 3 and no copay for days 4 through 90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Community Blue Medicare PPO Signature (PPO) covers outpatient services with no coinsurance, featuring a $350 copay for outpatient hospital and daily observation services, and a $275 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $45 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Community Blue Medicare PPO Signature (PPO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Community Blue Medicare PPO Signature (PPO) covers ground and air ambulance services with a $275 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, though trips to any other health-related locations are not covered.
Emergency Services See details
Community Blue Medicare PPO Signature (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 3 days. Urgently needed services have a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $115, $40, and $275 respectively.
Primary Care See details
Community Blue Medicare PPO Signature (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, and mental health services require copays ranging from $35 to $45 and no coinsurance. Chiropractic services are partially covered, offering routine care for a $15 copay and no coinsurance, but other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under Community Blue Medicare PPO Signature (PPO), offering no copay and no coinsurance for annual physical exams, kidney disease education, and routine screenings. Covered supplemental benefits include memory fitness (with no copay and no coinsurance), remote access technologies (with a copay ranging from no copay to $35 and no coinsurance), and home safety devices (with a 20% coinsurance and no copay). However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, and counseling are not covered.
Hearing Services See details
Community Blue Medicare PPO Signature (PPO) partially covers hearing services, providing routine hearing exams for a $25 copay and prescription hearing aids with a $699 to $999 copay up to a $500 annual limit, both with no coinsurance. Hearing aid fittings and evaluations, OTC hearing aids, and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Community Blue Medicare PPO Signature (PPO) provides partially covered vision services, featuring one routine eye exam per year for a $35 copay and no coinsurance, with other eye exam services not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, offering up to a $350 combined annual maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Community Blue Medicare PPO Signature (PPO) up to an annual maximum of $2,500, with no copay and no coinsurance for preventive care, and a $35 copay and no coinsurance for Medicare-covered dental. Comprehensive services such as restorative and endodontic care have no copay and 20% coinsurance, while other diagnostic and preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Community Blue Medicare PPO Signature (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Community Blue Medicare PPO Signature (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Community Blue Medicare PPO Signature (PPO) with no copays, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic shoes or inserts carry a 20% coinsurance, while diabetic supplies range from no coinsurance to 20% coinsurance and are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Community Blue Medicare PPO Signature (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Diagnostic procedures and tests carry a copay of $0 to $10, lab services have no copay, outpatient x-rays have a $20 copay, and diagnostic and therapeutic radiological services require minimum copays of $195 and $60, respectively.
Home Health Services See details
Community Blue Medicare PPO Signature (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Community Blue Medicare PPO Signature (PPO) plan, meaning cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Community Blue Medicare PPO Signature (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not, and additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Other Services are partially covered by Community Blue Medicare PPO Signature (PPO), offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $40 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this benefit.
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