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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 for prescription drugs. During the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay at a preferred pharmacy, while standard generic drugs have 25% coinsurance. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Complete Blue PPO Choice Deluxe (PPO) plan offers a range of benefits beyond standard Medicare coverage. This includes coverage for inpatient and outpatient services, with varying copays depending on the specific service, such as a $415 copay for inpatient hospital stays, and a $350 copay for outpatient hospital services. The plan also provides coverage for primary care, preventive, hearing, vision, and dental services, with copays ranging from $15 to $30 for primary care visits, $25 for hearing exams, and a $25 copay for eye exams and dental services. Additional benefits include ambulance and emergency services with copays between $50 and $280, as well as home health services with no copay. The plan also covers medical equipment, diagnostic and radiological services, and skilled nursing facility stays with copays or coinsurance requirements. However, it's important to note that certain services like acupuncture, private duty nursing, and some rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric care, are covered under the Complete Blue PPO Choice Deluxe (PPO) plan. For Inpatient Hospital-Acute, there is a $415 copay per admission or stay for Medicare-covered stays, with no copay for additional days. For Inpatient Hospital Psychiatric, there is 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 for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for the Complete Blue PPO Choice Deluxe (PPO) plan include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $350 copay, while ambulatory surgical center services have a $250 copay. Individual and group sessions for outpatient substance abuse have a copay between $45 and $45.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the Complete Blue PPO Choice Deluxe (PPO) plan. There is no additional information about the cost of services for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including services not usually covered by Medicare plans, are covered under the Complete Blue PPO Choice Deluxe (PPO) plan. Ground and air ambulance services each have a $280 copay, while transportation services to any health-related location are 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, 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 physician services, chiropractic services with a $15 copay, occupational therapy services with a $20 copay, physician specialist services with a $25 copay, and mental health specialty services with a $30 copay. The plan also covers podiatry services with a $25 copay, other health care professional services with a copay between $0 and $25, psychiatric services with a $30 copay, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a copay between $0 and $50, and opioid treatment program services with a $45 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, as well as annual physical exams. Additional preventive services are covered, but some services like health education, in-home safety assessments, and counseling services are not covered. Remote Access Technologies have a copay between $0 and $25, and Home and Bathroom Safety Devices and Modifications have a 20% coinsurance.
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 per year with a copay of $15. Prescription hearing aids are covered up to a maximum of $500 per year, with a copay between $699 and $999 per hearing aid (2 per year). Fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a $25 copay. Eyewear is covered, 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 Complete Blue PPO Choice Deluxe (PPO) plan offers dental services with a $25 copay for Medicare dental services. Other dental services include oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment, all of which are covered, and have a maximum benefit of $5,000 per year. Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with a 50% coinsurance. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance; other Medicare Part B drugs have 0-20% coinsurance.
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, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. 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 require authorization. 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 by the Complete Blue PPO Choice Deluxe (PPO) plan, 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 are not covered.
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, and self-directed personal assistance services. Over-the-counter (OTC) items are covered.
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