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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 Western, 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 $2.00. 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay for one-month and three-month supplies when using a preferred retail pharmacy or preferred mail-order service. If you use a standard pharmacy or standard mail order, Tier 1 drugs carry a $7 to $21 copay, while Tier 2 drugs cost between $15 and $45. For brand-name and specialty medications, costs are structured as coinsurance. Tier 3 preferred brand drugs require a 20% coinsurance, and Tier 4 non-preferred drugs have a 29% coinsurance at all pharmacy types. Tier 5 specialty drugs require a 25% coinsurance for a one-month supply whether you use preferred or standard pharmacies and mail-order options.
Additional Benefits
The Complete Blue PPO Signature (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, home health services, and partial hospitalization. Specialist visits require a $35 copay, while inpatient hospital stays feature a $165 daily copay for the first five days and no copay thereafter. Emergency care is available for a $130 copay, and outpatient hospital services carry a $245 copay, both with no coinsurance. For ancillary benefits, the plan provides preventive dental care and routine eyewear up to a $400 annual limit with no copay and no coinsurance. Routine hearing exams require a $20 copay, and dental comprehensive services are covered with no copay and a 20% coinsurance. Additionally, members benefit from an over-the-counter allowance of up to $95 every three months with no copays or coinsurance.
Inpatient Hospital See details
Complete Blue PPO Signature (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute inpatient stays require a $165 copay for days 1 to 5 and no copay for days 6 and beyond, while psychiatric stays require a $425 copay for days 1 to 3 and no copay for days 4 to 90, with upgrades and non-Medicare-covered stays excluded from coverage.
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 services require a $45 copay per session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Complete Blue PPO Signature (PPO) with no copay and no coinsurance. This ensures you receive full coverage for these services with zero out-of-pocket costs.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Complete Blue PPO Signature (PPO) plan, with ground and air ambulance services requiring a $325 copay and no coinsurance. Transportation services are partially covered, offering unlimited one-way rides to plan-approved locations with no copay and no coinsurance, while 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 and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $40, and $325 respectively.
Primary Care See details
Complete Blue PPO Signature (PPO) primary care physician services are covered with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Other services like therapy, mental health, and podiatry feature copays ranging from $0 to $45 with no coinsurance, though chiropractic care is only partially covered because other chiropractic services are not covered.
Preventive Services See details
Preventive services offered by Complete Blue PPO Signature (PPO) are covered with no copay and no coinsurance for annual physical exams, kidney disease education, and other Medicare-covered preventive screenings. Additional preventive benefits are partially covered, featuring memory fitness, remote access technologies with a $0 to $35 copay, and home safety modifications with a 20% coinsurance, while services like health education, personal emergency response systems, and in-home support are not covered.
Hearing Services See details
Hearing services are partially covered under Complete Blue PPO Signature (PPO), which offers routine hearing exams for a $20 copay and prescription hearing aids with copays ranging from $699 to $999, both with no coinsurance. While prescription aids have a $500 annual maximum benefit, fitting and evaluation exams, OTC hearing aids, and inner, outer, or over-the-ear devices are not covered.
Vision Services See details
Complete Blue PPO Signature (PPO) partially covers vision services, featuring a $35 copay and no coinsurance for one routine eye exam yearly, though other eye exam services are not covered. Covered eyewear, including lenses, frames, contacts, and upgrades, has no copay and no coinsurance up to a combined maximum benefit of $400 per year.
Dental Services See details
Complete Blue PPO Signature (PPO) offers partially covered dental services, featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care up to a $2,500 annual limit. Comprehensive care is covered with no copay and 20% coinsurance (0% to 20% for adjunctive services), though 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 and no coinsurance, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% 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 copays, though prior authorization is required for these services. Durable medical equipment carries coinsurance ranging from no coinsurance up to 50%, diabetic supplies range from no coinsurance up to 20% coinsurance, and prosthetics, medical supplies, and diabetic shoes require a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Complete Blue PPO Signature (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required for these services. Lab services have no copay, diagnostic tests and procedures carry a $0 to $10 copay, outpatient X-rays require a $20 copay, and therapeutic and diagnostic radiological services have minimum copays of $60 and $195, respectively.
Home Health Services See details
Complete Blue PPO Signature (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Complete Blue PPO Signature (PPO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Complete Blue PPO Signature (PPO) partially 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, which includes over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $95 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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