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Complete Blue PPO Choice Deluxe (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Complete Blue PPO Choice Deluxe (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 Choice Deluxe (PPO) in 2025, please refer to our full plan details page.
Complete Blue PPO Choice Deluxe (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 2025.
It's important to know that Complete Blue PPO Choice Deluxe (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 Choice Deluxe (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 Choice Deluxe (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $6.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $9550.00 (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 $9550.00 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 Complete Blue PPO Choice Deluxe (PPO)
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Drug Coverage
The Complete Blue PPO Choice Deluxe (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and a $20 copay at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Complete Blue PPO Choice Deluxe (PPO) plan offers a range of benefits with varying cost-sharing. Hospital stays have a copay, and outpatient services, including doctor visits, have copays ranging from $15 to $300. Emergency and ambulance services are covered with copays, and there are no copays for preventive services. The plan includes vision, hearing, and dental coverage with copays, and offers coverage for home health, skilled nursing facilities, and home infusion services, with some services requiring prior authorization. There is also coverage for medical equipment and dialysis services with coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services; Inpatient Hospital-Acute has a $325 copay per admission, and Inpatient Hospital Psychiatric has a $425 copay for days 1-3, and no copay for days 4-90. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered, and Upgrades for Inpatient Hospital-Acute is not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, have a $300 copay. Ambulatory Surgical Center (ASC) Services have a $200 copay, and outpatient substance abuse services have a $45 copay for both individual and group sessions. Outpatient blood services are also covered, with a waived deductible for three pints.
Partial Hospitalization See details
Partial Hospitalization is covered by the Complete Blue PPO Choice Deluxe (PPO) plan. There is no information available about the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Complete Blue PPO Choice Deluxe (PPO) plan. Ground and Air Ambulance Services each have a $400 copay, and Transportation Services to a plan-approved health-related location are covered, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Complete Blue PPO Choice Deluxe (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $50 copay; Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $400 copay.
Primary Care See details
The Complete Blue PPO Choice Deluxe (PPO) plan covers primary care services, including physician services, chiropractic services with a $15 copay, occupational therapy services with a $20 copay, physician specialist services with a $25 copay, mental health specialty services with a $40 copay, podiatry services with a $25 copay, other health care professional services with a copay between $0 and $25, psychiatric services with a $40 copay, physical therapy and speech-language pathology services with a $20 copay, telehealth services with a copay between $0 and $50, and opioid treatment program services with a $45 copay. Routine chiropractic care and routine foot care are limited to 4 visits per year.
Preventive Services See details
Preventive services include coverage for Medicare-covered zero dollar preventive services, annual physical exams, additional preventive services, kidney disease education services, and other preventive services, with no copay. Home and bathroom safety devices and modifications have a 20% coinsurance, and remote access technologies have a copay between $0 and $25. Some services like health education, in-home safety assessment, counseling services, and more are not covered.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $25 copay, including Routine Hearing Exams with a $10 copay for 1 visit per year, but Fitting/Evaluation for Hearing Aid is not covered. Prescription Hearing Aids are covered with a maximum benefit of $500 per year and a copay between $699 and $999 for 2 visits per year, but OTC Hearing Aids, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $25 copay, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames and upgrades. Eyewear has a combined maximum plan benefit coverage of $400 every year.
Dental Services See details
The Complete Blue PPO Choice Deluxe (PPO) plan covers Medicare dental services for a $25 copay, and other dental services with a maximum benefit of $6,000 per year. Oral exams, dental x-rays, cleaning, and fluoride treatments are covered, while restorative services, endodontics, periodontics, removable prosthodontics, fixed prosthodontics, and oral and maxillofacial surgery are covered with 50% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. You will pay a $35 copay for Medicare Part B Insulin Drugs, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Complete Blue PPO Choice Deluxe (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Complete Blue PPO Choice Deluxe (PPO) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. The plan also covers Diabetic Equipment, including Diabetic Supplies with 0-20% coinsurance and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered. Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $225, Therapeutic Radiological Services have a copay of at most $75, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Complete Blue PPO Choice Deluxe (PPO) plan with no copay or 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 technically covered, but none of the sub-services are covered, including 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, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services offered by the Complete Blue PPO Choice Deluxe (PPO) plan include coverage for Over-the-Counter (OTC) Items, but 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 are not covered. There is no copay or coinsurance for the covered OTC items.
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