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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 $28.00. 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 a preferred pharmacy or through preferred mail order. Tier 2 generic drugs cost a $3 copay for a 1-month supply at preferred pharmacies, while standard pharmacies charge a $15 copay. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 23% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance rates apply across all preferred and standard pharmacy and mail-order options.
Additional Benefits
The Community Blue Medicare PPO Signature (PPO) plan offers comprehensive coverage for your everyday healthcare needs, featuring no copays for primary care doctor visits, preventive care, and annual physicals. If you require specialist visits, emergency care, or outpatient hospital services, you will pay predictable flat copayments with no coinsurance, such as a $35 copay for specialists and a $115 copay for emergency visits. Inpatient hospital stays are also covered without coinsurance, requiring a $175 daily copay for the first five days and no copay for subsequent days. This plan also includes valuable benefits for dental, vision, and hearing services, providing preventive dental care with no copay and an annual routine eye exam for a $35 copay. Additionally, home health services are available with no copay or coinsurance, while durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay. Members also receive a quarterly allowance of up to $50 for over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Community Blue Medicare PPO Signature (PPO) partially covers inpatient hospital services with no coinsurance, though non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered. Acute stays require a $175 copayment per day for days 1 through 5 (with no copayment thereafter), while psychiatric stays require a $425 copayment per day for days 1 through 3 (with no copayment for days 4 through 90).
Outpatient Services See details
Community Blue Medicare PPO Signature (PPO) covers outpatient hospital and daily observation services with a $350 copay and no coinsurance, and ambulatory surgical center services with a $275 copay and no coinsurance. Outpatient substance abuse sessions are covered with a $45 copay and no coinsurance, while outpatient blood services require no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Community Blue Medicare PPO Signature (PPO) 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 $260 copay and no coinsurance. Transportation services are partially covered, offering unlimited one-way trips to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Community Blue Medicare PPO Signature (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with copays of $115, $40, and $260 respectively, and no coinsurance.
Primary Care See details
Community Blue Medicare PPO Signature (PPO) covers primary care provider visits with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Additional services like therapy, telehealth, and mental health sessions have copays ranging from $0 to $45 with no coinsurance, while chiropractic care is partially covered because other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under the Community Blue Medicare PPO Signature (PPO) plan, offering no copay and no coinsurance for annual physicals, kidney disease education, and standard screenings. While remote access technologies require a $0 to $35 copay and home safety devices have a 20% coinsurance, multiple sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, 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.
Hearing Services See details
Hearing services are partially covered by Community Blue Medicare PPO Signature (PPO), featuring a $25 copay and no coinsurance for routine annual hearing exams, and prescription hearing aids with copays ranging from $699 to $999 and no coinsurance. No deductible applies, but fitting evaluations, OTC hearing aids, and inner, outer, or over-the-ear prescription aid types are not covered.
Vision Services See details
Community Blue Medicare PPO Signature (PPO) provides partially covered vision services, including one annual routine eye exam for a $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $350 yearly combined maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Community Blue Medicare PPO Signature (PPO), offering preventive care with no copay and no coinsurance, and Medicare-covered dental with a $35 copay and no coinsurance. Comprehensive benefits are covered up to a $2,500 annual limit with no copay and 20% coinsurance, but other diagnostic and preventive dental 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, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Community Blue Medicare PPO Signature (PPO) plan 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 and a 20% coinsurance for durable medical equipment, prosthetics, and diabetic shoes, while diabetic supplies range from no coinsurance to 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies 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. Lab services have no copay, diagnostic tests have a copay of up to $10, outpatient X-rays cost $20, and diagnostic and therapeutic radiological services require minimum copays of $195 and $60, respectively.
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, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Community Blue Medicare PPO Signature (PPO) plan. All sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Community Blue Medicare PPO Signature (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100 per stay. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Community Blue Medicare PPO Signature (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $50 every three months. Acupuncture and meal benefits are not covered under this plan.
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