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Complete Blue PPO Signature (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Complete Blue PPO Signature (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Complete Blue PPO Signature (PPO) in 2025, please refer to our full plan details page.
Complete Blue PPO Signature (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2025 to people living in Northwestern PA. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Complete Blue 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 Complete Blue 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 Complete Blue 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 $8.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8950.00 (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 $8950.00 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 Complete Blue PPO Signature (PPO) plan has an enhanced alternative drug benefit with no deductible. In the initial coverage phase, you will pay a $0 copay for preferred generic drugs at a preferred pharmacy, and 25% coinsurance for standard generic drugs at either pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Complete Blue PPO Signature (PPO) plan offers a range of benefits with varying costs. Hospital stays have copays ranging from $0 to $425 depending on the service, while outpatient services have copays between $45 and $225. Emergency services have copays between $50 and $390. The plan also covers a variety of services with copays, including primary care, hearing, vision, and dental. Additionally, the plan provides coverage for home health services, skilled nursing facilities, and medical equipment with a coinsurance. Other benefits include coverage for home infusion, dialysis, and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits for Complete Blue PPO Signature (PPO) include coverage for Inpatient Hospital-Acute with a $250 copay per admission or stay, and Inpatient Hospital Psychiatric with a $425 copay for days 1-3, and no copay for days 4-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $225 copay, ambulatory surgical center services have a $175 copay, and individual and group outpatient substance abuse sessions have a $45 copay. Outpatient blood services include an enhanced benefit of a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Complete Blue PPO Signature (PPO) plan. There is no additional cost for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Complete Blue PPO Signature (PPO) plan. Ground and air ambulance services have a copay of $390.00, and there is no coinsurance. Transportation Services to a plan-approved health-related location are covered, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Complete Blue PPO Signature (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $50 copay, while Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $390 copay.
Primary Care See details
Complete Blue PPO Signature (PPO) covers primary care services, including chiropractic services with a $15 copay, occupational therapy with a $30 copay, physician specialist services with a $20 copay, mental health services with a $40 copay for individual and group sessions, and podiatry services with a $20 copay. The plan also covers physical therapy and speech-language pathology services with a $20 copay, telehealth services with a copay between $0 and $50, and opioid treatment program services with a $45 copay.
Preventive Services See details
The Complete Blue PPO Signature (PPO) plan covers preventive services, including Medicare-covered services with no copay, as well as an annual physical exam. Additional preventive services are covered, with a copay of $0-$20 for remote access technologies, and 20% coinsurance for home and bathroom safety devices. Some services, such as health education and counseling services, are not covered.
Hearing Services See details
Hearing exams are covered with a $20 copay, with Routine Hearing Exams limited to 1 visit per year. Prescription hearing aids are covered, with a maximum plan benefit of $500 per year, and Prescription Hearing Aids (all types) have a copay between $699 and $999 for up to 2 visits per year. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams with a $20 copay. Eyewear is covered with a combined maximum of $400 per year for both in and out-of-network services, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames and upgrades.
Dental Services See details
Dental services include a $20 copay for Medicare dental services, with other dental services covered with a maximum benefit of $2500 per year. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, each limited to one visit per specified period. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with a 20% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Complete Blue PPO Signature (PPO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and also requires authorization, while Prosthetics/Medical Supplies has a 20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests and Lab Services are not covered. For Diagnostic Radiological Services, the copay is at most $195, for Therapeutic Radiological Services the copay is at most $60, and for Outpatient X-Ray Services the copay is $20.
Home Health Services See details
Home Health Services are covered by the Complete Blue PPO Signature (PPO) plan, with no copay or coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Complete Blue PPO Signature (PPO) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Complete Blue PPO Signature (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, which offers a maximum benefit of $150 every three months, but excludes Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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