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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 North Central 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 $7.00. 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 $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 Choice Deluxe (PPO) plan has an enhanced alternative drug benefit. The plan has no deductible. In the initial coverage phase, you will pay no copay for preferred generic drugs at a preferred pharmacy, and 25% coinsurance for standard generic drugs at a preferred pharmacy. For non-preferred drugs, you will pay 33% coinsurance.
Additional Benefits
The Complete Blue PPO Choice Deluxe (PPO) plan offers a wide array of benefits with varying costs. This plan covers inpatient hospital stays with a copay, outpatient services with copays ranging from $45 to $350, and ambulance services with a $280 copay. Emergency services have copays between $50 and $125, and primary care services have copays between $15 and $45, with some services having a coinsurance. Preventive services include coverage for additional services, with some services having a coinsurance. The plan also covers vision services with a $25 copay for eye exams and eyewear benefits. Dental services are covered with a $25 copay for Medicare dental and a 50% coinsurance for other services. Home health, skilled nursing, and dialysis services are covered with either no copay or coinsurance required.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Complete Blue PPO Choice Deluxe (PPO) plan, including Inpatient Hospital-Acute with a $415 copay per admission for Medicare-covered stays, and Inpatient Hospital Psychiatric with a $425 copay for days 1-3 and no copay for days 4-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while 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 are covered by the Complete Blue PPO Choice Deluxe (PPO) plan, including outpatient hospital services and observation services with a $350 copay, ambulatory surgical center services with a $250 copay, and outpatient substance abuse services. Individual and group sessions for outpatient substance abuse have a copay between $45 and $45. Outpatient blood services are also covered, and this plan waives the three-pint deductible.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Complete Blue PPO Choice Deluxe (PPO) plan. There is no additional information 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 have a copay of $280, with no coinsurance. Transportation Services to a plan-approved health-related location are covered, 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 by the Complete Blue PPO Choice Deluxe (PPO) plan. Emergency Services have a $125 copay, 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 $280 copay.
Primary Care See details
The Complete Blue PPO Choice Deluxe (PPO) plan covers primary care, chiropractic, occupational therapy, physician specialist, mental health specialty, podiatry, other health care professional, psychiatric, physical therapy and speech-language pathology, additional telehealth, and opioid treatment program services. Chiropractic and routine foot care services have a $15 copay, physician specialist services have a $25 copay, occupational therapy and physical therapy have a $20 copay, individual and group mental health and psychiatric sessions have a $30 copay, and opioid treatment program services have a $45 copay. Additional telehealth services have a copay between $0 and $50, and other health care professional services have a copay between $0 and $25.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services, annual physical exams, and additional preventive services. Additional preventive services include some services with a coinsurance of 20% for home and bathroom safety devices and modifications, and a copay between $0 and $25 for remote access technologies.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $25 copay, and prescription hearing aids with a copay between $699 and $999 for up to two visits per year, with a maximum benefit of $500 per year. 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 eye exams with a $25 copay, and eyewear with a combined maximum benefit of $400 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Complete Blue PPO Choice Deluxe (PPO) plan covers dental services with a $25 copay for Medicare dental services. Other dental services include oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment, with specific limitations on the number of visits and periodicity, and restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with a 50% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 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 benefits under the Complete Blue PPO Choice Deluxe (PPO) plan include Durable Medical Equipment (DME) with 20% coinsurance and requiring authorization, Prosthetics/Medical Supplies with no copay and a coinsurance for Medicare-covered items, and Diabetic Equipment with varying coinsurance based on the specific supply. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered. Diagnostic Procedures/Tests and Lab Services are not covered, while Diagnostic Radiological Services have a copay of at most $295, 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 and no coinsurance, but additional hours of care and personal care services are not covered. 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 under the Complete Blue PPO Choice Deluxe (PPO) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services under the Complete Blue PPO Choice Deluxe (PPO) plan include Over-the-Counter (OTC) Items, but 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. The plan does provide OTC items as a supplemental benefit under Part C, but does not cover all drugs on the CMS OTC list.
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