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Community Blue Medicare Plus PPO Signature (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community Blue Medicare Plus 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 Plus PPO Signature (PPO) in 2026, please refer to our full plan details page.
Community Blue Medicare Plus PPO Signature (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2025 to people living in Lycoming and Sullivan, 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 Plus 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 Plus 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 Plus 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 $17.00. 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 Plus 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 a preferred pharmacy or through preferred mail order, while standard pharmacies charge a $7 copay for a 1-month supply. Tier 2 generic drugs are also affordable, costing a $3 copay for a 1-month supply at a preferred pharmacy compared to a $15 copay at a standard pharmacy. For higher-tier medications, the plan transitions from flat copays to coinsurance. Tier 3 preferred brand drugs require a 23% coinsurance for both 1-month and 3-month supplies across all pharmacy and mail-order options. Non-preferred drugs in Tier 4 and specialty drugs in Tier 5 both carry a 25% coinsurance across all prescription filling methods.
Additional Benefits
The Community Blue Medicare Plus PPO Signature (PPO) plan offers comprehensive medical coverage with no coinsurance for most core services, including inpatient hospital stays, primary care, and emergency care. Patients enjoy no copay for primary care visits, preventive screenings, and partial hospitalization, while specialist visits require a $35 copay. Inpatient acute hospital stays require a $175 daily copay for the first five days, after which there is no copay. For supplemental benefits, the plan features no copay for preventive dental care, routine eyewear up to a $350 annual limit, and home health services. Routine hearing exams carry a $20 copay, and members receive a $100 quarterly allowance for over-the-counter items with no copay or coinsurance. Other services, such as dialysis and durable medical equipment, are covered with no copay and a standard 20% coinsurance.
Inpatient Hospital See details
Community Blue Medicare Plus PPO Signature (PPO) covers inpatient acute hospital stays with no coinsurance, requiring a $175 daily copay for days 1 through 5 and no copay for days 6 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric stays are also covered with no coinsurance, requiring a $425 daily copay for days 1 through 3 and no copay for days 4 through 90, while upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered under the Community Blue Medicare Plus PPO Signature (PPO) plan with no coinsurance, featuring a $350 copay for outpatient hospital and observation services and a $300 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, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered under the Community Blue Medicare Plus PPO Signature (PPO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Community Blue Medicare Plus PPO Signature (PPO), with ground and air ambulance services requiring a $260 copay and no coinsurance. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Community Blue Medicare Plus 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 Plus PPO Signature (PPO) covers primary care visits with no copay and no coinsurance, and specialist visits for a $35 copay and no coinsurance. Therapy, mental health, podiatry, and telehealth services require copays ranging from $0 to $45 with no coinsurance, while chiropractic benefits are only partially covered because other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered under the Community Blue Medicare Plus PPO Signature (PPO) plan, featuring annual physicals, kidney disease education, and screenings with no copay and no coinsurance. Additional preventive benefits are partially covered, including remote access technologies with a copay ranging from no copay to $35 and safety devices with a 20% coinsurance. However, health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission 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
Community Blue Medicare Plus PPO Signature (PPO) partially covers hearing services with no coinsurance, featuring a $35 copay for hearing exams ($20 for routine annual exams) and copays between $699 and $999 for prescription hearing aids up to a $500 annual maximum. Fitting evaluations, OTC hearing aids, and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Community Blue Medicare Plus PPO Signature (PPO), as other eye exam services are not covered. Routine eye exams are covered once annually with a $35 copay and no coinsurance, and eyewear is covered with no copay and no coinsurance up to a $350 annual maximum.
Dental Services See details
Community Blue Medicare Plus PPO Signature (PPO) offers partially covered dental services up to a $2,500 annual maximum, featuring a $35 copay and no coinsurance for Medicare-covered dental. Preventive care is available with no copay and no coinsurance, while covered comprehensive services require no copay and a 20% coinsurance (0% to 20% for adjunctive services). Non-covered services include other diagnostic and preventive services, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
Community Blue Medicare Plus PPO Signature (PPO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other infusion drugs have no copay and between no coinsurance and 20% coinsurance, while Part B insulin is covered with a $35 copay and up to 20% coinsurance.
Dialysis Services See details
The Community Blue Medicare Plus PPO Signature (PPO) plan covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Community Blue Medicare Plus PPO Signature (PPO) covers medical equipment, prosthetics, and diabetic supplies with no copays, though prior authorization is required. Covered durable medical equipment, prosthetics, and diabetic shoes carry a 20% coinsurance, while diabetic supplies range from no coinsurance to 20% coinsurance depending on the manufacturer.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Community Blue Medicare Plus PPO Signature (PPO) with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic tests range from no copay to $10, and outpatient X-rays carry a $20 copay, while diagnostic and therapeutic radiological services have minimum copays of $195 and $60, respectively.
Home Health Services See details
Home Health Services are covered by Community Blue Medicare Plus PPO Signature (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Community Blue Medicare Plus PPO Signature (PPO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage, meaning the plan's typical no copay and no coinsurance benefits do not apply.
Skilled Nursing Facility (SNF) See details
Community Blue Medicare Plus PPO Signature (PPO) 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, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Community Blue Medicare Plus PPO Signature (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $100 every three months. Acupuncture, meal benefits, and other supplemental services in this category are not covered.
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