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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 2026 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 $12.00. 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 drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a one-month or three-month supply at a preferred pharmacy, as well as for a three-month preferred mail order. Tier 2 generic drugs are also highly affordable, with copays starting at just $3 for a one-month supply at preferred pharmacies. For higher-tier medications, this plan transitions from flat copays to coinsurance. Tier 3 preferred brand drugs require a 23% coinsurance across all pharmacy and mail order options. Both Tier 4 non-preferred drugs and Tier 5 specialty drugs incur a 25% coinsurance, helping you plan your prescription expenses accordingly.
Additional Benefits
The Community Blue Medicare PPO Signature (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, while specialist visits require a $35 copay. Inpatient hospital stays feature a $175 daily copay for the first five days and no copay thereafter, while outpatient hospital services carry a $350 copay. Emergency room visits require a $115 copay, which is waived if you are admitted, and urgent care has a $40 copay. For additional wellness benefits, preventive dental and home health services are available with no copay and no coinsurance, alongside a $2,500 annual limit on covered dental care. Routine eye exams require a $35 copay, but the plan provides up to $350 annually for eyewear with no copay. Additionally, durable medical equipment and dialysis are covered with no copay and a 20% coinsurance, and members receive up to a $50 allowance every three months for over-the-counter items.
Inpatient Hospital See details
Community Blue Medicare PPO Signature (PPO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization. For acute stays, you pay a $175 copay per day for days 1 to 5 and no copay for days 6 and beyond, whereas psychiatric stays require a $425 copay per day for days 1 to 3 and no copay for days 4 to 90. 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 observation services, a $300 copay for ambulatory surgical center services, and a $45 copay for outpatient substance abuse sessions. Outpatient blood services are also 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 $315 copay and no coinsurance. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Community Blue Medicare PPO Signature (PPO) with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 3 days. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $115, $40, and $315 respectively.
Primary Care See details
Community Blue Medicare PPO Signature (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Other outpatient services like mental health, physical therapy, and podiatry have copays ranging from $0 to $45 and no coinsurance, though chiropractic care is only partially covered because other chiropractic services are not covered.
Preventive Services See details
Community Blue Medicare PPO Signature (PPO) covers preventive services, offering annual physical exams, kidney disease education, and screenings with no copay and no coinsurance. Additional benefits are partially covered, featuring remote access technologies with a $0 to $35 copay and no coinsurance, and home safety devices with a 20% coinsurance and no copay, while services like health education, personal emergency response systems, and nutritional therapy are not covered.
Hearing Services See details
Community Blue Medicare PPO Signature (PPO) partially covers hearing services, offering routine hearing exams with a $25 copay and no coinsurance, while fitting evaluations and OTC hearing aids are not covered. Prescription hearing aids are covered with no coinsurance and copays ranging from $699 to $999 up to a $500 annual maximum, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Community Blue Medicare PPO Signature (PPO), which features a $35 copay and no coinsurance for one routine annual eye exam, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $350 combined annual maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
Community Blue Medicare PPO Signature (PPO) provides partially covered dental services up to a $2,500 annual limit, with no copay and no coinsurance for preventive care. Medicare-covered services require a $35 copay and no coinsurance, while covered comprehensive care has no copay and 20% coinsurance (0% to 20% for adjunctive services). Other diagnostic, other preventive, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Community Blue Medicare PPO Signature (PPO) with no copay and no coinsurance, subject to prior authorization. Medicare Part B chemotherapy and other drugs have no copay and a 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Community Blue Medicare PPO Signature (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Community Blue Medicare PPO Signature (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required, and diabetic supplies range from no coinsurance up to a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Community Blue Medicare PPO Signature (PPO) with no coinsurance, though prior authorization is required. Diagnostic tests and procedures have a $0 to $10 copay, lab services have no copay, and outpatient X-rays require a $20 copay. Diagnostic radiological services have a minimum $195 copay, while therapeutic radiological services carry a minimum $60 copay.
Home Health Services See details
Home Health Services are covered by Community Blue Medicare PPO Signature (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Community Blue Medicare PPO Signature (PPO) provides coverage for Cardiac Rehabilitation Services with no copay and no coinsurance. While some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Community Blue Medicare PPO Signature (PPO) 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 inpatient hospital stay is not required, and additional days beyond the standard 100 days 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 $50 maximum benefit every three months. Acupuncture and meal benefits are not covered under this plan.
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