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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 $11.00. 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 and offers significant savings on generic medications. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at preferred pharmacies, while standard pharmacies charge a $7 copay for a 1-month supply. Tier 2 generic drugs cost a low $3 copay for a 1-month supply at preferred pharmacies and a $15 copay at standard pharmacies. For higher-tier medications, cost-sharing transitions from flat copays to coinsurance. Tier 3 preferred brand drugs require a 23% coinsurance across all pharmacy and mail order options. Tier 4 non-preferred drugs and Tier 5 specialty medications both carry a 25% coinsurance for a 1-month supply at both preferred and standard pharmacies.
Additional Benefits
The Community Blue Medicare PPO Signature (PPO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, preventive screenings, and annual physical exams. For more intensive care, inpatient hospital stays require a daily copay for the first five days followed by no copay, while emergency room visits carry a $115 copay that is waived upon admission. Outpatient procedures, diagnostic tests, and skilled nursing care are also covered, typically with no coinsurance and predictable copays. Beyond standard medical care, this plan provides valuable supplemental benefits, including dental services with no copay for preventive care and an annual maximum allowance of $2,500. Vision and hearing benefits include routine exams with copays, alongside annual coverage allowances for prescription eyewear and hearing aids. Members also enjoy no copay for over-the-counter health items and unlimited one-way transportation to plan-approved medical locations.
Inpatient Hospital See details
Community Blue Medicare PPO Signature (PPO) inpatient hospital services are partially covered with no coinsurance, though prior authorization is required. Acute stays require a $175 daily copay for days 1-5 and no copay for days 6-90, while psychiatric stays require a $425 daily copay for days 1-3 and no copay for days 4-90; hospital 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, including outpatient hospital and daily observation services for a $350 copay, and ambulatory surgical center services for a $275 copay. Outpatient substance abuse sessions require a $45 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Community Blue Medicare PPO Signature (PPO) plan with no copay and no coinsurance for eligible services.
Ambulance and Transportation Services See details
Community Blue Medicare PPO Signature (PPO) covers ambulance services with a $260 copay and no coinsurance for both ground and air transport. Transportation services are partially covered, offering unlimited one-way trips to plan-approved health-related locations with no copay and no coinsurance, but trips to any health-related location are 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 require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $115, $40, and $260 respectively.
Primary Care See details
Community Blue Medicare PPO Signature (PPO) offers primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require a $35 copay and no coinsurance. Chiropractic services are partially covered, offering up to four routine visits per year for a $15 copay and no coinsurance, while other chiropractic services are not covered. Mental health, psychiatric, podiatry, and telehealth services are also covered with copays ranging from $0 to $45 and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Community Blue Medicare PPO Signature (PPO), offering annual physical exams, kidney disease education, and other preventive screenings with no copay and no coinsurance. While remote access technologies ($0 to $35 copay) and home safety devices (20% coinsurance) are covered, various supplemental services like health education and personal emergency response systems are not covered.
Hearing Services See details
Community Blue Medicare PPO Signature (PPO) partially covers hearing services with no deductible or coinsurance. Routine hearing exams are covered once annually with a $25 copay ($35 copay for other hearing exams), and prescription hearing aids are covered up to $500 annually with copays from $699 to $999, while OTC hearing aids, fitting evaluations, and inner, outer, or over-the-ear prescription aids are not covered.
Vision Services See details
Community Blue Medicare PPO Signature (PPO) offers partially covered vision services, which include 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 up to a combined annual maximum benefit of $350 for contact lenses, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered by Community Blue Medicare PPO Signature (PPO) with an annual maximum of $2,500, excluding other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics. Medicare-covered dental requires a $35 copay and no coinsurance, preventive services have no copay and no coinsurance, and covered comprehensive services carry no copay and 20% coinsurance (0% to 20% for adjunctive services).
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. Associated Medicare Part B drugs, including chemotherapy and insulin, require no coinsurance up to 20% coinsurance, with insulin also carrying a $35 copay.
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
Community Blue Medicare PPO Signature (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic equipment and supplies are also covered with no copay and coinsurance ranging from no coinsurance to 20%, though prior authorization is required and diabetic supplies are limited to specified manufacturers.
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. Lab services have no copay, diagnostic procedures and tests have a $0 to $10 copay, and outpatient X-rays have a $20 copay. Diagnostic and therapeutic radiological services require minimum copays of $195 and $60, respectively.
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
Cardiac Rehabilitation Services are not covered under the Community Blue Medicare PPO Signature (PPO) plan. This means there is no coverage for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Community Blue Medicare PPO Signature (PPO) with no coinsurance and require prior authorization, with no prior three-day hospital stay required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Community Blue Medicare PPO Signature (PPO), which offers over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $50 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this benefit.
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