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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 2025, 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 Counties: TA, CN, LG, SN. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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 $20.00. 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 $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 has an "Enhanced Alternative" drug benefit. This plan has a $0 deductible. In the initial coverage phase, you'll pay a $5 copay for preferred generic drugs at preferred pharmacies, and 25% coinsurance for standard generic drugs at preferred pharmacies. For non-preferred drugs, you'll pay 33% coinsurance. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Community Blue Medicare Plus PPO Signature (PPO) plan offers coverage for a wide range of services, including inpatient and outpatient care, with varying copays. You'll find no copay for preventive services and home health services, but copays apply to doctor visits, specialist care, and other services. This plan includes coverage for hearing, vision, and dental services, with specific copays and annual maximums for hearing aids, eye exams, and dental care. Additionally, the plan covers ambulance services, emergency care, and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $400 copay per admission for a Medicare-covered stay, and additional days have no copay. For Inpatient Hospital Psychiatric, you will pay a $425 copay for days 1-3 and no copay for days 4-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $350 copay, while ambulatory surgical center services have a $275 copay. Individual and group sessions for outpatient substance abuse have a copay between $45 and $45.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Community Blue Medicare Plus PPO Signature (PPO) plan. Ground and air ambulance services each have a $300 copay, while transportation services to any health-related location are covered. Transportation services to any health-related location are covered, including sedan, stretcher van, and wheelchair van.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under this plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $30 copay, and Worldwide Emergency Transportation has a $300 copay; there is no coinsurance for any of these services.
Primary Care See details
The Community Blue Medicare Plus PPO Signature (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $25 copay, and mental health specialty services with a $40 copay for individual and group sessions. This plan also covers podiatry services with a $25 copay, other health care professional services with a copay ranging from $0 to $25, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a copay ranging from $0 to $45, and opioid treatment program services with a $45 copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams, additional preventive services, kidney disease education services, and other preventive services. Fitness benefits are covered, as are remote access technologies with a copay between $0 and $25, and home and bathroom safety devices with a 20% coinsurance. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, telemonitoring services, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, and prescription hearing aids with a copay between $699 and $999 with a maximum plan benefit of $500 every year, some services are not covered including fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids.
Vision Services See details
Vision services include coverage for eye exams with a $25 copay, and eyewear with a combined maximum plan benefit of $350 every year for both in-network and out-of-network services, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are covered once per year.
Dental Services See details
The Community Blue Medicare Plus PPO Signature (PPO) plan covers dental services with a $25 copay for Medicare dental services, and a $2,500 maximum benefit per year for other dental services. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, and have limits on the number of visits covered and the frequency of the service. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with a 20% coinsurance, and also have limits on the number of visits covered and the frequency of the service. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Community Blue Medicare Plus PPO Signature (PPO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Community Blue Medicare Plus PPO Signature (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices with a 20% coinsurance. Diabetic Supplies are covered with between 0% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $10, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at least $195, Therapeutic Radiological Services have a copay of at least $60, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Community Blue Medicare Plus PPO Signature (PPO) plan with no copay and no 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 this plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Community Blue Medicare Plus PPO Signature (PPO), with a $0 copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, with a maximum benefit coverage amount of $165.00 every three months, but does not cover Acupuncture, Meal Benefits, 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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