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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 2025, 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 PA. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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 $24.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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 has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $5 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Community Blue Medicare PPO Signature (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the service. Emergency, primary care, and preventive services are included, with some services having no copay. The plan also covers hearing, vision, and dental services, with set copays and annual maximums for hearing aids and dental services. Additional benefits include ambulance and transportation services, home health services with no copay, and coverage for medical equipment and home infusion services with coinsurance. There is also coverage for skilled nursing facility services with a copay, and other services such as diagnostic, radiological, and dialysis services. Certain services like cardiac rehabilitation, acupuncture, and certain types of care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, there is a $350 copay per admission or stay for Medicare-covered stays, and additional days are covered with no copay, while Non-Medicare-covered stays and upgrades are not covered. Inpatient Hospital Psychiatric has a $425 copay for days 1-3, and no copay for days 4-90, while additional days and Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $350 copay, Observation Services with a $350 copay per day, Ambulatory Surgical Center (ASC) Services with a $275 copay, Outpatient Substance Abuse Services with a $45 copay for both individual and group sessions, and Outpatient Blood Services. All services require prior authorization except for Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Community Blue Medicare PPO Signature (PPO) plan. Ground and air ambulance services have a $250 copay, and there is no coinsurance. Transportation Services to a plan-approved health-related location are covered. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Community Blue Medicare PPO Signature (PPO). Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $30 copay, and Worldwide Emergency Transportation has a $250 copay; all have no coinsurance. Worldwide Urgent Coverage has a $30 copay and no coinsurance.
Primary Care See details
The Community Blue Medicare PPO Signature (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy with a $30 copay, physician specialist services with a $25 copay, mental health specialty services with a $40 copay for individual and group sessions, podiatry services with a $25 copay, other health care professional services with a copay between $0 and $25, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $45, and opioid treatment program services with a $45 copay. Routine Chiropractic Care is limited to 4 visits per year.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, annual physical exams, and additional preventive services. Additional preventive services may have a copay and coinsurance, and some sub-services, such as Health Education, In-Home Safety Assessment, and Counseling Services, are not covered. Remote Access Technologies have a copay from $0 to $25, and Home and Bathroom Safety Devices and Modifications have 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Routine hearing exams have a $25 copay, with a limit of one exam per year, and fitting/evaluation for hearing aids is not covered. Prescription hearing aids have a maximum plan benefit of $500 per year, and all types of prescription hearing aids have a copay between $699 and $999 for up to two visits per year, while inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $25 copay, and eyewear with a combined maximum benefit of $350 per year for both in-network and out-of-network services. This plan also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services are covered under the Community Blue Medicare PPO Signature (PPO) plan. The plan covers Medicare dental services with a $25 copay, and also covers other dental services with a $2,500 maximum benefit per year. Some services like Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Community Blue Medicare PPO Signature (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. There is a 20% coinsurance for durable medical equipment, Medicare-covered prosthetic devices, medical supplies, and diabetic therapeutic shoes/inserts, while diabetic supplies have a coinsurance between 0% and 20%. Durable medical equipment for use outside of the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $10, lab services with no copay, diagnostic radiological services with a copay of at least $195, therapeutic radiological services with a copay of at least $60, and outpatient X-ray services with a $20 copay. Prior authorization is required.
Home Health Services See details
Home Health Services are covered by the Community Blue Medicare PPO Signature (PPO) plan with no copay and no coinsurance, but require authorization. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Community Blue Medicare PPO Signature (PPO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Community Blue Medicare PPO Signature (PPO) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Community Blue Medicare PPO Signature (PPO) plan does not cover acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services. Over-the-Counter (OTC) Items are covered with a maximum benefit of $145 every three months.
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