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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 2026 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 $6.00. 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) Medicare plan features an annual prescription drug deductible of $615. For generic medications, members enjoy no copay on tier 1 preferred generics and tier 2 generics when using a preferred pharmacy or preferred mail order. Standard pharmacies and standard mail order options increase costs to a $7 copay for tier 1 and a $15 copay for tier 2 generic drugs for a one-month supply. For brand-name and specialty medications, costs are structured as coinsurance across all pharmacy and mail order networks. Tier 3 preferred brands require 20% coinsurance, tier 4 non-preferred drugs carry 29% coinsurance, and tier 5 specialty drugs have a 25% coinsurance. These coinsurance rates remain consistent whether you use preferred or standard delivery methods.
Additional Benefits
The Complete Blue PPO Signature (PPO) plan offers robust coverage for core medical services, featuring no copays or coinsurance for primary care visits and standard preventive care. For specialist visits, urgent care, and emergency room services, members pay flat copays of $40, $40, and $130 respectively, with no coinsurance. Inpatient hospital stays require a $195 daily copay for the first five days, after which there is no copay, while outpatient hospital services carry a $265 daily copay. This plan also includes valuable supplemental benefits, such as preventive dental care and routine eyewear with no copays, alongside a $2,500 annual dental maximum and a $400 annual eyewear allowance. Routine hearing and vision exams are available with low copays of $20 and $40, and prescription hearing aids are covered with copays ranging from $699 to $999. Additionally, members receive a $65 quarterly allowance for over-the-counter items with no copay or coinsurance, and home health services are covered with no copay.
Inpatient Hospital See details
Complete Blue PPO Signature (PPO) covers inpatient hospital services with no coinsurance, though the benefit is only partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. For acute care, there is a $195 copay for days 1 to 5 and no copay for subsequent days, while psychiatric stays require a $425 copay for days 1 to 3 and no copay for days 4 through 90.
Outpatient Services See details
Complete Blue PPO Signature (PPO) covers outpatient services with no coinsurance, featuring a $265 copay per day for outpatient hospital and observation services, and a $215 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $45 copay and 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) partially covers ambulance and transportation services, featuring ground and air ambulance services for a $400 copay and no coinsurance. Unlimited one-way transportation to plan-approved health-related locations is covered with no copay and no coinsurance, but transportation to any 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 and urgent care are covered with no coinsurance and copays ranging from $40 to $400.
Primary Care See details
Complete Blue PPO Signature (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, mental health, and podiatry visits require a $40 copay and no coinsurance. Physical, occupational, and speech therapy services have a $25 copay and no coinsurance, and chiropractic care is partially covered with a $15 copay and no coinsurance for routine care, while 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 standard benefits like annual physicals, kidney disease education, and glaucoma screenings. Some supplemental benefits are covered, such as remote access technologies with a $0 to $40 copay and home safety devices with 20% coinsurance, while services like health education, personal emergency response systems, and nutritional counseling are not covered.
Hearing Services See details
Complete Blue PPO Signature (PPO) covers one routine hearing exam per year with a $20 copay and no coinsurance, though hearing aid fittings and OTC hearing aids are not covered. The plan also covers up to two prescription hearing aids annually with no coinsurance and copays ranging from $699 to $999, subject to a $500 maximum yearly benefit.
Vision Services See details
Complete Blue PPO Signature (PPO) partially covers vision services, offering one routine eye exam per year with a $40 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $400 combined annual maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
Complete Blue PPO Signature (PPO) offers partially covered dental services with a $2,500 annual maximum, featuring a $40 copay and no coinsurance for Medicare-covered dental. Preventive services require no copay and no coinsurance, while comprehensive dental services require 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
Home Infusion bundled Services are covered by Complete Blue PPO Signature (PPO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, have coinsurance ranging from no coinsurance to 20%, with insulin requiring 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, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and required prior authorization. Durable medical equipment carries no coinsurance to 50% coinsurance, while prosthetics, medical supplies, and diabetic shoes and supplies carry up to 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. Lab services have no copay, diagnostic 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 $200, 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
Complete Blue PPO Signature (PPO) covers some services with no copay and no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Complete Blue PPO Signature (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required and a prior three-day inpatient hospital stay is not needed, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Complete Blue PPO Signature (PPO), which offers over-the-counter (OTC) items with no copay and no coinsurance up to a $65 maximum limit every three months. Acupuncture and meal benefits are not covered under this plan.
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