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Complete Blue Plus PPO Choice Deluxe (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Complete Blue Plus 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 Plus PPO Choice Deluxe (PPO) in 2025, please refer to our full plan details page.
Complete Blue Plus PPO Choice Deluxe (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2025 to people living in Counties: TA, CN, LG, SN. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Complete Blue Plus 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 Plus 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 Plus 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:
Sign up for Complete Blue Plus PPO Choice Deluxe (PPO)
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Drug Coverage
The Complete Blue Plus PPO Choice Deluxe (PPO) plan has an "Enhanced Alternative" drug benefit type. There is no deductible for prescription drugs. During 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. You will pay 50% coinsurance for preferred brand drugs at a preferred pharmacy, and 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you will enter the next coverage phase.
Additional Benefits
The Complete Blue Plus PPO Choice Deluxe (PPO) plan offers a range of benefits including inpatient and outpatient hospital services, with varying copays depending on the service. Primary care visits have no copay, while specialist visits and other services like chiropractic and therapy have copays. The plan also covers services like hearing and vision exams and dental services. This plan provides coverage for emergency services and ambulance services, with copays for each. Additionally, it includes preventive services, hearing aids, and durable medical equipment with varying cost-sharing amounts. The plan also covers skilled nursing facilities and home health services, and other services, while excluding services like cardiac rehabilitation and certain other services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, are covered. For Inpatient Hospital-Acute, you will have a $415 copay per admission, and additional days have no copay. For Inpatient Hospital Psychiatric, you will have a $425 copay for days 1-3, and no copay for days 4-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services and Observation Services have a $350 copay, Ambulatory Surgical Center (ASC) Services have a $250 copay, and individual and group sessions for Outpatient Substance Abuse have a copay between $45 and $45.
Partial Hospitalization See details
Partial Hospitalization is covered by the Complete Blue Plus PPO Choice Deluxe (PPO) plan. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Complete Blue Plus PPO Choice Deluxe (PPO) plan. Ground and air ambulance services have a copay of $280.00, and there is no coinsurance. 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 by Complete Blue Plus PPO Choice Deluxe (PPO). Emergency Services have a $125 copay, and Urgently Needed Services have a $50 copay; both have no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $280 copay; all have no coinsurance.
Primary Care See details
Complete Blue Plus PPO Choice Deluxe (PPO) covers primary care, including primary care physician services, with no copay. Chiropractic services have a $15 copay, and occupational therapy services, physical therapy, and speech-language pathology services have a $20 copay. Physician specialist services have a $25 copay, and mental health specialty services and psychiatric services have a $30 copay for individual and group sessions. Podiatry services and opioid treatment program services have a $25 and $45 copay, respectively. Additional telehealth benefits have a copay between $0 and $50.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services, annual physical exams, and other preventive services. Additional preventive services may include a coinsurance for Home and Bathroom Safety Devices and Modifications, and a copay for Remote Access Technologies. Certain services like Health Education, Counseling Services, and others are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, and prescription hearing aids. Hearing exams have a $25 copay, and routine hearing exams have a $15 copay. Prescription hearing aids are covered up to $500 every year, with a copay of $699-$999 per visit. 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 include eye exams with a $25 copay, and eyewear with a combined maximum benefit of $400 every 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
Dental Services are covered, including Medicare Dental Services with a $25 copay. Other services include oral exams, dental x-rays, cleaning, and fluoride treatment, with Oral Exams and Cleaning limited to one visit every six months, and Dental X-Rays and Fluoride Treatment limited to one visit 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. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Complete Blue Plus PPO Choice Deluxe (PPO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical equipment is covered under the Complete Blue Plus PPO Choice Deluxe (PPO) plan. Durable medical equipment has a 20% coinsurance, and requires authorization. Prosthetic devices have a 20% coinsurance, while medical supplies have a 20% coinsurance with no copay. Diabetic supplies have between 0% and 20% coinsurance, while diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. 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 Plus PPO Choice Deluxe (PPO) plan with no copay and no coinsurance, but require authorization. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Complete Blue Plus PPO Choice Deluxe (PPO) plan. This includes 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 under the Complete Blue Plus PPO Choice Deluxe (PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Complete Blue Plus PPO Choice Deluxe (PPO) plan's "Other Services" benefit covers over-the-counter items, but 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.
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