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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 $23.00. 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 will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay a $5 copay for preferred generic drugs at a preferred pharmacy. Once your total drug costs reach $2,000, 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 range of benefits with varying cost-sharing. For inpatient hospital stays, there is a copay, but outpatient, partial hospitalization, and home health services have no copays. The plan also covers ambulance, emergency, and worldwide emergency services with copays, as well as primary care, hearing, vision, and dental services, each with their own copays and coverage limits. Additional benefits include coverage for medical equipment, diagnostic services, and skilled nursing facility stays with varying copays or coinsurance. The plan also provides coverage for home infusion, dialysis, and other services like over-the-counter items, with specific limitations and coverage amounts. However, some services like cardiac rehabilitation, and certain other services are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $350 copay for a Medicare-covered stay and no copay for additional days, 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; additional days and Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services includes coverage for outpatient hospital services and observation services with a $350 copay, Ambulatory Surgical Center (ASC) Services with a $275 copay, and outpatient substance abuse services with a $45 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization benefits are 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 by the Community Blue Medicare PPO Signature (PPO) plan. Ground and air ambulance services each have a $250 copay, with no coinsurance, and transportation services to plan-approved health-related locations 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 the Community Blue Medicare PPO Signature (PPO) plan. Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a $20 copay and no coinsurance. Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $20 copay, and Worldwide Emergency Transportation has a $250 copay; all have 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 with a $30 copay, physician specialist services with a $25 copay, mental health specialty services with a $40 copay, podiatry services with a $25 copay, other health care professional services with a copay ranging from $0 to $25, psychiatric services with a $40 copay, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a copay ranging from $0 to $45, and opioid treatment program services with a $45 copay. Routine chiropractic care and routine foot care are 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, with some services like Health Education, Counseling Services, and others not covered. Remote Access Technologies have a copay between $0 and $25, and Home and Bathroom Safety Devices and Modifications have a 20% coinsurance.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $25 copay, Routine Hearing Exams (1 per year) with a copay of $25, and Prescription Hearing Aids with a plan-specified amount up to $500 every year and a copay between $699-$999 depending on the hearing aid. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $25 copay. Eyewear benefits are covered, with a combined maximum of $350 per year for both in and out-of-network services. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, with a $25 copay for Medicare Dental Services. Other dental services are covered, with a $2,500 maximum benefit per year. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, with some limitations on the number of visits and periodicity. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed) and oral and maxillofacial surgery are covered with a 20% coinsurance. 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. Medicare Part B Insulin Drugs have a $35 copay, and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Community Blue Medicare PPO Signature (PPO). You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment with 20% coinsurance, prosthetic devices with a 20% coinsurance, medical supplies with 20% coinsurance, and diabetic equipment including diabetic supplies with 0-20% coinsurance and diabetic therapeutic shoes/inserts with 20% coinsurance. Durable medical equipment for use outside 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 for all diagnostic and radiological services.
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 authorization is required. 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. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Community Blue Medicare PPO Signature (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services offered by the Community Blue Medicare PPO Signature (PPO) plan include Over-the-Counter (OTC) Items, with a maximum benefit coverage amount of $145.00 every three months, but 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.
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