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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 $24.00. 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 1-month or 3-month supply at preferred pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, with a 1-month supply costing a $3 copay at preferred pharmacies compared to a $15 copay at standard pharmacies. For higher-tier medications, the plan utilizes 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 percentages apply equally across both preferred and standard pharmacy and mail order options.
Additional Benefits
The Community Blue Medicare PPO Signature (PPO) plan offers affordable coverage with no copay for primary care visits, preventive screenings, lab services, and home health care. For more specialized medical needs, members pay a $35 copay for specialist visits, a $115 copay for emergency room care, and a $350 copay for outpatient hospital services with no coinsurance. Inpatient hospital stays are also covered with no coinsurance, requiring a $175 daily copay for days one through five. In addition to core medical care, this plan provides robust supplemental benefits including dental, vision, and hearing coverage. Preventive dental care has no copay, while comprehensive dental services require a 20% coinsurance up to a $2,500 annual maximum. Members also benefit from a $350 annual eyewear allowance and a $40 quarterly over-the-counter credit with no copay.
Inpatient Hospital See details
Community Blue Medicare PPO Signature (PPO) inpatient hospital benefits are partially covered with no coinsurance, requiring a $175 copay for days 1 through 5 of acute stays and a $425 copay for days 1 through 3 of psychiatric stays, with no copay for subsequent days. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Community Blue Medicare PPO Signature (PPO) covers outpatient hospital and observation services with a $350 copay and no coinsurance, and ambulatory surgical center services with a $300 copay and no coinsurance. Outpatient substance abuse sessions require a $45 copay and no coinsurance, while outpatient blood services are available with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization is covered by the Community Blue Medicare PPO Signature (PPO) plan with no copay and no coinsurance required for services.
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 to plan-approved health-related locations are covered with no copay and no coinsurance, but this benefit is only partially covered as 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, which is waived if you are admitted to the hospital within 3 days. Urgently needed services require a $40 copay with no coinsurance, and worldwide emergency services are covered with no coinsurance and copays of $40 for urgent care, $115 for emergency care, and $260 for emergency transportation.
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. Chiropractic services are partially covered, excluding other chiropractic services, with a $15 copay and no coinsurance for routine visits. Other covered benefits, such as therapy, mental health, and podiatry, require copays ranging from $30 to $45 and no coinsurance.
Preventive Services See details
Community Blue Medicare PPO Signature (PPO) preventive services are partially covered, offering annual physicals, kidney disease education, and routine screenings with no copay and no coinsurance, alongside remote access technologies for a $0 to $35 copay and home safety devices with a 20% coinsurance. Excluded from coverage are health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, 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), offering routine hearing exams with a $20 to $35 copay and no coinsurance, while fitting evaluations and OTC hearing aids are not covered. Prescription hearing aids are covered up to a $500 annual maximum with no coinsurance and copays ranging from $699 to $999, though inner ear, outer ear, and over-the-ear types are excluded.
Vision Services See details
Community Blue Medicare PPO Signature (PPO) offers partially covered vision services with no deductibles, as other eye exam services are not covered. Routine eye exams are covered once per year with a $35 copay and no coinsurance, while eyewear is covered with no copay, no coinsurance, and a $350 annual maximum benefit.
Dental Services See details
Dental services are partially covered by Community Blue Medicare PPO Signature (PPO) up to a $2,500 annual maximum, offering preventive care with no copay and no coinsurance, and comprehensive services with no copay and a 20% coinsurance. Medicare-covered dental has a $35 copay and no coinsurance, but other diagnostic dental, other preventive dental, 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, subject to prior authorization. Covered Medicare Part B drugs—including chemotherapy, radiation, and insulin—subject patients to coinsurance ranging from no coinsurance up to 20%, with insulin drugs additionally 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 durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance, though 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 carry a copay of up to $10, and radiological services require copays of $20 for X-rays, at least $60 for therapeutic radiation, and at least $195 for diagnostic radiology.
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
Community Blue Medicare PPO Signature (PPO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Community Blue Medicare PPO Signature (PPO) 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 per stay, while additional days beyond Medicare-covered limits are not covered.
Other Services See details
Other services are partially covered by Community Blue Medicare PPO Signature (PPO), which features 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 under this benefit.
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