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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 2026, 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 Erie, Lawrence, Mercer, PA. This plan received an overall rating of 4.5 out of 5 stars in 2026.
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 $9.00. 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 $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 features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generics and Tier 2 generics when using preferred pharmacies or preferred mail order services. If you choose standard pharmacies or standard mail order, Tier 1 copays range from $7 to $21, while Tier 2 copays range from $15 to $45. Higher-tier medications require coinsurance instead of flat copays at all pharmacy locations. You will pay a 20% coinsurance for Tier 3 preferred brands, a 30% coinsurance for Tier 4 non-preferred drugs, and a 25% coinsurance for Tier 5 specialty drugs.
Additional Benefits
The Complete Blue PPO Signature (PPO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay for primary care visits, preventive screenings, and home health services. For specialized care, members pay a $30 copay for specialist visits, a $130 copay for emergency room visits, and a $175 daily copay for the first five days of an inpatient hospital stay. Outpatient hospital services and ambulance transport are covered with copays of $245 and $260 respectively, with no coinsurance required for most of these core medical services. In addition to standard medical care, this plan provides valuable supplemental benefits including dental, vision, and hearing coverage. Dental benefits offer up to a $2,500 annual limit with no copay for preventive care, while vision benefits include a $400 annual allowance for eyewear with no copay. Members also benefit from a $40 quarterly allowance for over-the-counter items with no copay, as well as a skilled nursing facility benefit that requires no copay for the first 20 days of care.
Inpatient Hospital See details
Complete Blue PPO Signature (PPO) covers inpatient acute hospital stays with no coinsurance and a $175 daily copay for days 1 to 5, with no copay thereafter for unlimited additional days. Inpatient psychiatric care is also covered with no coinsurance and a $425 daily copay for days 1 to 3, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Complete Blue PPO Signature (PPO) covers outpatient services with no coinsurance, featuring a $245 copay for outpatient hospital and daily observation services, and a $195 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $45 copay with no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the Complete Blue PPO Signature (PPO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Complete Blue PPO Signature (PPO) covers ambulance services with a $260 copay and no coinsurance for both ground and air transport. Transportation services to plan-approved health-related locations are covered with no copay and no coinsurance, though transportation to any other health-related location is not covered.
Emergency Services See details
Complete Blue PPO Signature (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within three days, and no coinsurance. Urgently needed services have a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $40, and $260 respectively.
Primary Care See details
Complete Blue PPO Signature (PPO) covers primary care physician visits with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Therapy, mental health, telehealth, and podiatry services are covered with copays ranging from $0 to $45 and no coinsurance, while chiropractic services are partially covered because other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Complete Blue PPO Signature (PPO), featuring no copay and no coinsurance for annual physicals, kidney disease education, and other preventive screenings. Additional covered benefits include memory fitness, remote access technologies (no coinsurance and a $0 to $30 copay), and home safety devices (20% coinsurance and no copay). However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, and counseling are not covered.
Hearing Services See details
Complete Blue PPO Signature (PPO) partially covers hearing services, offering routine exams for a $20 copay (up to $30 for other exams) and no coinsurance, while fitting evaluations and over-the-counter hearing aids are not covered. Prescription hearing aids are covered with no coinsurance and copays from $699 to $999 up to a $500 annual limit, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Complete Blue PPO Signature (PPO) offers partially covered vision services with no deductibles, featuring one annual routine eye exam with a $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, offering a $400 annual maximum benefit for contacts, frames, lenses, and upgrades.
Dental Services See details
Complete Blue PPO Signature (PPO) offers partially covered dental services with an annual maximum benefit of $2,500, featuring Medicare-covered dental for a $30 copay and no coinsurance, and preventive care with no copay and no coinsurance. Comprehensive services such as restorative, endodontics, periodontics, and prosthodontics are covered with no copay and 20% coinsurance (0% to 20% for adjunctive), while other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Complete Blue PPO Signature (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy and other drugs have no copay and require no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Complete Blue PPO Signature (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Complete Blue PPO Signature (PPO) covers medical equipment with no copay, though prior authorization is required for these services. Durable medical equipment incurs no coinsurance to 50% coinsurance, prosthetics and medical supplies require 20% coinsurance, and covered diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Complete Blue PPO Signature (PPO) with no coinsurance, although prior authorization is required. Members pay no copay for lab services, a $0 to $10 copay for diagnostic tests, a $20 copay for outpatient X-rays, and minimum copays of $60 for therapeutic radiology and $195 for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the Complete Blue PPO Signature (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Complete Blue PPO Signature (PPO) plan 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.
Skilled Nursing Facility (SNF) See details
Complete Blue PPO Signature (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient 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 Medicare-covered limit are not covered.
Other Services See details
Complete Blue PPO Signature (PPO) partially covers other services, providing 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.
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