A non-government entity
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:
Sign up for Community Blue Medicare PPO Signature (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Community Blue Medicare PPO Signature (PPO) plan has an annual drug deductible of $615, with significant cost savings available when using preferred pharmacies. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at preferred pharmacies and preferred mail order, compared to a $7 copay for a 1-month supply at standard pharmacies. Tier 2 generic drugs cost a low $3 copay for a 1-month supply at preferred pharmacies, while standard pharmacies charge a $15 copay. For higher-tier medications, costs are determined by 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 both carry a 25% coinsurance across all pharmacy and mail-order options. Choosing preferred pharmacies and mail-order services is the most effective way to minimize your out-of-pocket prescription costs with this plan.
Additional Benefits
The Community Blue Medicare PPO Signature (PPO) plan offers robust coverage with no copay and no coinsurance for primary care visits, select preventive services, and home health care. Specialist visits require a $35 copay, while inpatient hospital stays carry a $175 daily copay for the first five days and no copay for subsequent days. Emergency room visits have a $115 copay, and urgently needed care requires a $40 copay, both with no coinsurance. For additional wellness benefits, the plan features preventive dental care and routine eyewear with no copay, including a $350 annual limit for glasses and contacts. Routine hearing exams require a $20 to $35 copay, while prescription hearing aids are covered with copays ranging from $699 to $999. Members also benefit from unlimited rides to approved health locations with no copay, and a $40 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Community Blue Medicare PPO Signature (PPO) covers inpatient acute hospital stays with no coinsurance and a $175 daily copay for days 1 to 5 (no copay for days 6 and beyond), excluding upgrades and non-Medicare-covered stays. Inpatient psychiatric hospital stays are also covered with no coinsurance, requiring a $425 daily copay for days 1 to 3 and no copay for days 4 to 90, though additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Community Blue Medicare PPO Signature (PPO) covers outpatient services with no coinsurance, including outpatient hospital and observation services for a $350 copay, and ambulatory surgical center services for a $300 copay. Outpatient substance abuse sessions require a $45 copay and no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
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, requiring prior authorization. Transportation services are partially covered, providing unlimited one-way rides to plan-approved health-related locations with no copay or coinsurance, while transportation to other health-related locations is not covered.
Emergency Services See details
Community Blue Medicare PPO Signature (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 3 days, and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $115, $40, and $260 respectively.
Primary Care See details
Community Blue Medicare PPO Signature (PPO) provides primary care doctor visits with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Other services such as therapy, telehealth, and mental health services carry copays ranging from $0 to $45 with no coinsurance, although chiropractic care is only partially covered as other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Community Blue Medicare PPO Signature (PPO), offering annual physicals, kidney disease education, and select screenings with no copay and no coinsurance. Remote access technologies require a $0 to $35 copay and no coinsurance, while home safety devices require a 20% coinsurance and no copay. Uncovered services include health education, PERS, in-home assessments, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day services, nutritional benefits, palliative care, in-home support, caregiver support, telemonitoring, and counseling.
Hearing Services See details
Community Blue Medicare PPO Signature (PPO) partially covers hearing services with no deductible, offering routine hearing exams for a $20 copay (or $35 for general hearing exams) and no coinsurance, while fitting and evaluation services are not covered. Prescription hearing aids are covered with a $699 to $999 copay and no coinsurance up to a $500 annual maximum, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Community Blue Medicare PPO Signature (PPO) offers partially covered vision services, which include one routine eye exam per year 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 $350 combined annual maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Community Blue Medicare PPO Signature (PPO), providing up to $2,500 annually with a $35 copay and no coinsurance for Medicare-covered dental, no copay or coinsurance for preventive care, and no copay with 0% to 20% coinsurance for comprehensive services. Sub-services that are not covered under this plan include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Community Blue Medicare PPO Signature (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and 0% 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, though prior authorization is required for these services. Covered durable medical equipment, prosthetics, medical supplies, and diabetic shoes carry a 20% coinsurance, while diabetic supplies from specified manufacturers range from no coinsurance to 20% coinsurance.
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 procedures and tests range from a $0 to $10 copay, outpatient X-rays require a $20 copay, and diagnostic and therapeutic radiological services have minimum copays of $195 and $60 respectively.
Home Health Services See details
Community Blue Medicare PPO Signature (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Community Blue Medicare PPO Signature (PPO) with no copay and no coinsurance. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Community Blue Medicare PPO Signature (PPO) partially covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Other Services are partially covered under the Community Blue Medicare PPO Signature (PPO) plan, featuring Over-the-Counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $40 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved