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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 has an annual drug deductible of $615. You can save on generic medications with no copay for Tier 1 preferred generics and Tier 2 generics when using a preferred pharmacy or preferred mail order. If you use standard pharmacies or standard mail order, Tier 1 drugs have a $7 copay for a one-month supply, while Tier 2 generics cost $15. For brand-name and specialty medications, your costs are based on a percentage of the drug cost rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, and Tier 4 non-preferred drugs carry a 29% coinsurance. Specialty Tier 5 prescriptions have a 25% coinsurance for a one-month supply at both preferred and standard locations.
Additional Benefits
The Complete Blue PPO Signature (PPO) plan offers robust medical coverage with predictable cost-sharing, including no copay for primary care doctor visits and a $35 copay for specialists. For hospital care, inpatient stays require a $175 daily copay for the first five days and no copay thereafter, while outpatient hospital services carry a $255 copay. Additionally, emergency room visits have a $130 copay, which is waived if you are admitted, and there is no coinsurance for these core medical services. This plan also features valuable supplemental benefits, such as dental coverage up to a $2,500 annual limit with no copay for preventive care and a 20% coinsurance for comprehensive services. Vision and hearing benefits include routine exams with low copays, alongside a $400 annual allowance for eyewear and up to a $500 annual maximum for prescription hearing aids. Furthermore, members benefit from unlimited rides to approved health locations and a $95 quarterly over-the-counter allowance with no copays.
Inpatient Hospital See details
Complete Blue PPO Signature (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $175 daily copay for days 1 through 5 and no copay for days 6 and beyond, while psychiatric stays incur a $425 daily copay for days 1 through 3 and no copay for days 4 through 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Complete Blue PPO Signature (PPO) covers outpatient services with no coinsurance, featuring a $255 copay for outpatient hospital and daily observation services, and a $205 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 and no coinsurance.
Partial Hospitalization See details
Complete Blue PPO Signature (PPO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Complete Blue PPO Signature (PPO) covers ground and air ambulance services with a $425 copay and no coinsurance. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, while rides to non-approved health-related locations are 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 require a $40 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $40, and $425 respectively.
Primary Care See details
Complete Blue PPO Signature (PPO) offers primary care doctor visits with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Other primary care benefits are partially covered, featuring physical therapy at a $25 copay and routine chiropractic care at a $15 copay (both with no coinsurance), though other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Complete Blue PPO Signature (PPO), offering annual physicals, kidney education, and screenings with no copay and no coinsurance, while remote access technologies have a $0 to $35 copay and home safety devices require a 20% coinsurance. However, health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy 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) provides partial coverage for hearing services with no deductible and no coinsurance. Routine hearing exams are covered once yearly with a $20 copay, while fitting evaluations, OTC hearing aids, and inner, outer, or over-the-ear prescription aids are not covered. Covered prescription hearing aids have an annual maximum benefit of $500 and require a copay of $699 to $999.
Vision Services See details
Vision services are partially covered by Complete Blue PPO Signature (PPO), which features a $35 copay and no coinsurance for one annual routine eye exam, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance, offering up to a $400 combined annual maximum for contact lenses, eyeglass lenses, frames, and upgrades.
Dental Services See details
Complete Blue PPO Signature (PPO) partially covers dental services up to a $2,500 annual limit, offering preventive care with no copay and no coinsurance, and Medicare-covered dental with a $35 copay and no coinsurance. Covered comprehensive services like restorative, endodontics, periodontics, prosthodontics, and oral surgery require no copay and 20% coinsurance (0% to 20% for adjunctive services), while other diagnostic and preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Complete Blue PPO Signature (PPO) with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, insulin, and other drugs require no coinsurance to 20% coinsurance, with insulin carrying a $35 copay.
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. Members pay no coinsurance to 50% coinsurance for durable medical equipment, 20% coinsurance for prosthetics and medical supplies, and no coinsurance to 20% coinsurance for diabetic equipment and supplies.
Diagnostic and Radiological Services See details
Complete Blue PPO Signature (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic tests carry a copay of $0 to $10, outpatient X-rays cost $20, and diagnostic and therapeutic radiological services require minimum copayments of $200 and $60, respectively.
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 not covered under the Complete Blue PPO Signature (PPO) plan, which does not cover cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Complete Blue PPO Signature (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Complete Blue PPO Signature (PPO) offers partial coverage for other services, providing over-the-counter (OTC) items with no copay and no coinsurance up to a maximum limit of $95 every three months. Acupuncture, meal benefits, and nicotine replacement therapy are not covered.
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