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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 $2.00. 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. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D 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 wide array of benefits, including coverage for inpatient and outpatient hospital services, with copays ranging from $15 to $425. The plan also covers emergency services with a $110 copay, primary care, preventive services, and dental services with a $20 copay for Medicare services, and hearing services with a $20 copay for exams. Additional benefits include vision care with a $20 copay for eye exams and up to $350 per year for eyewear, along with coverage for ambulance, transportation, home health, and skilled nursing facility services. The plan also covers medical equipment, diagnostic and radiological services, and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with a $275 copay per admission or stay, and Inpatient Hospital Psychiatric with a $425 copay for days 1-3, and no copay for days 4-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital and Observation Services have a $300 copay, while Ambulatory Surgical Center Services have a $225 copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay between $45 and $45.
Partial Hospitalization See details
Partial Hospitalization is covered by the Community Blue Medicare PPO Signature (PPO) plan. There is no information about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Community Blue Medicare PPO Signature (PPO) plan. Both Ground and Air Ambulance Services have a $350 copay, while Transportation Services to any health-related location are 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 $350 copay; all of these services 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 services, physician specialist services with a $20 copay, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay between $0 and $45, and opioid treatment program services with a $45 copay. Chiropractic services, podiatry services, and additional telehealth benefits include services not usually covered by Medicare plans.
Preventive Services See details
The Community Blue Medicare PPO Signature (PPO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, and other preventive services. Additional preventive services may have a copay and coinsurance, Remote Access Technologies have a copay of $0-$20, and Home and Bathroom Safety Devices and Modifications have 20% coinsurance. Some services such as health education, counseling services, and telemonitoring services are not covered.
Hearing Services See details
Hearing Services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams have a $20 copay, with a limit of 1 exam per year. Prescription hearing aids are covered up to a maximum of $500 per year, with a copay between $699 and $999, depending on the type. Fitting/evaluation for hearing aids, prescription hearing aids for inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $20 copay, eyewear with a combined maximum of $350 per year for both in-network and out-of-network services, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are limited to one per year.
Dental Services See details
The Community Blue Medicare PPO Signature (PPO) plan covers dental services with a $20 copay for Medicare dental services, and a $2,500 maximum benefit per year for other dental services. Oral exams, dental x-rays, cleaning, and fluoride treatments are covered with specific limitations. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with 20% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Community Blue Medicare PPO Signature (PPO) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical equipment is covered by the Community Blue Medicare PPO Signature (PPO) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have a coinsurance between 0-20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a few cost-sharing details. Diagnostic services have no copay, while Diagnostic Radiological Services have a copay of at most $175, Therapeutic Radiological Services have a copay of at most $60, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Community Blue Medicare PPO Signature (PPO) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services, including 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, and self-directed personal assistance services are not covered. Over-the-counter items are covered up to $155 every three months.
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