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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. This plan has no deductible. In 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, while standard generic drugs have 25% coinsurance at both preferred and standard pharmacies. Once your total drug costs reach $2000, 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 variety of benefits. Inpatient hospital stays have a copay, starting at $415, while outpatient services range from no copay to a $350 copay. The plan covers emergency services with a copay, and also offers coverage for primary care, hearing, vision, and dental services, each with varying copays and coverage limits. Additional benefits include home health services with no copay, and skilled nursing facility stays with a $0 copay for the first 20 days. The plan also covers ambulance, diagnostic, and home infusion services. However, certain services such as acupuncture, private duty nursing, and specific rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you will pay a $415 copay per admission or stay, and there is no copay for additional days. For Inpatient Hospital Psychiatric, the copay is $425 for days 1-3, and no copay for days 4-90.
Outpatient Services See details
Outpatient Services are covered by the Complete Blue PPO Choice Deluxe (PPO) plan, including all outpatient hospital services, with a $350 copay for outpatient hospital services and observation services. Ambulatory Surgical Center (ASC) Services have a $250 copay, and outpatient substance abuse services have a $45 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Complete Blue PPO Choice Deluxe (PPO) plan. There is no additional information available 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 have a $280 copay, while transportation services to any health-related location are covered, but 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, and 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 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 $30 copay for individual or group sessions, podiatry services with a $25 copay, other health care professional services with a $0-$25 copay, psychiatric services with a $30 copay for individual or group sessions, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a $0-$50 copay, and opioid treatment program services with a $45 copay. Routine chiropractic care is limited to 4 visits per year.
Preventive Services See details
The Complete Blue PPO Choice Deluxe (PPO) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services. Additional preventive services include no copay, but the coinsurance is 20% for Home and Bathroom Safety Devices and Modifications, while Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) has a copay of up to $25. Some services, such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Hearing exams have a $25 copay, and routine hearing exams are limited to 1 visit per year with a copay between $15 and $15. Prescription hearing aids are limited to $500 per year, and have a copay between $699 and $999, with a limit of 2 visits per year. Fitting/evaluation for hearing aids, prescription hearing aids - inner ear, outer ear, and 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 also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $400 per year. Routine eye exams are covered once per year.
Dental Services See details
Dental Services include a $25 copay for Medicare dental services, and other dental services are covered with a $5,000 annual maximum benefit. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, while maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with a 50% coinsurance, and adjunctive general services have a coinsurance between 0% and 50%.
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 the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Complete Blue PPO Choice Deluxe (PPO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and authorization required, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying coinsurance depending on the service. Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests and Lab Services are not covered. 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 prior authorization is required; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
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 for SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required.
Other Services See details
The Complete Blue PPO Choice Deluxe (PPO) plan does not cover 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, or Self-Directed Personal Assistance Services. The plan covers Over-the-Counter (OTC) Items, but does not cover all drugs on the CMS OTC list.
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