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Community Blue Medicare Plus PPO Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community Blue Medicare Plus PPO Premier (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 Premier (PPO) in 2025, please refer to our full plan details page.
Community Blue Medicare Plus PPO Premier (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2025 to people living in Counties: TA, LG, SN, CN. 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 Premier (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 Premier (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 Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $55.00. 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 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 $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:
Sign up for Community Blue Medicare Plus PPO Premier (PPO)
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Drug Coverage
The Community Blue Medicare Plus PPO Premier (PPO) plan has an enhanced alternative drug benefit. You will not have to pay a deductible for your prescriptions. During the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Community Blue Medicare Plus PPO Premier (PPO) plan offers a range of benefits with varying costs. For inpatient hospital stays, there is a $250 copay, while outpatient services have copays ranging from $45 to $245. The plan also covers primary care with a $20-$30 copay, preventive services, hearing, vision, and dental services with a $3,000 annual maximum. Additionally, the plan includes coverage for ambulance, emergency, and home health services, plus home infusion, dialysis, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with a $250 copay per admission or stay for Medicare-covered stays, and Additional Days for Inpatient Hospital-Acute with no copay. Inpatient Hospital Psychiatric has 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 coverage for outpatient hospital services with a $245 copay, observation services with a $245 copay per day, ambulatory surgical center services with a $175 copay, and outpatient substance abuse services with a $45 copay for both individual and group sessions. Additionally, outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered under this plan. There is no additional information about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services each have a copay of $260. Transportation Services to a plan-approved health-related location are covered with no copay or coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Community Blue Medicare Plus PPO Premier (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $15 copay, and Worldwide Emergency Services have a copay of $125 for Worldwide Emergency Coverage, $15 for Worldwide Urgent Coverage, and $260 for Worldwide Emergency Transportation; all services have no coinsurance.
Primary Care See details
The Community Blue Medicare Plus PPO Premier (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services, physician specialist services, mental health specialty services with a $30 copay for individual and group sessions, podiatry services, other health care professional services, psychiatric services with a $30 copay for individual and group sessions, physical therapy and speech-language pathology services, additional telehealth benefits with a copay between $0 and $45, and opioid treatment program services with a $45 copay. Routine chiropractic care is limited to 8 visits per year.
Preventive Services See details
The Community Blue Medicare Plus PPO Premier (PPO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, and additional preventive services. Some services such as Health Education, Counseling Services, and others are not covered. Home and Bathroom Safety Devices and Modifications have a 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, and prescription hearing aids. The plan covers routine hearing exams with one visit per year, and prescription hearing aids with a copay between $699 and $999, up to a maximum of $500 per year for both in and out-of-network services. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include coverage for routine eye exams with one visit per year, and eyewear with a combined maximum benefit of $400 per year for both in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Community Blue Medicare Plus PPO Premier (PPO) plan covers dental services with a maximum benefit of $3,000 per year. Oral exams, dental x-rays, cleaning, fluoride treatments, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Community Blue Medicare Plus PPO Premier (PPO) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and 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 Premier (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Community Blue Medicare Plus PPO Premier (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies have a 20% coinsurance. Diabetic supplies have a coinsurance between 0% and 20%, and diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Community Blue Medicare Plus PPO Premier (PPO) plan. Diagnostic procedures/tests and lab services are not covered. Diagnostic Radiological Services have a copay of at most $150, Therapeutic Radiological Services have a copay of at most $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 Premier (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items, with a maximum plan benefit coverage amount of $180.00 every three months. Acupuncture, Meal Benefit, 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 are not covered.
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