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Complete Blue PPO Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Complete Blue PPO Choice (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 (PPO) in 2025, please refer to our full plan details page.
Complete Blue PPO Choice (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 (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 (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 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $19.00. You must continue to pay paying your reduced 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 $10000.00 (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 $10000.00 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 (PPO)
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Drug Coverage
The Complete Blue PPO Choice (PPO) plan has an "Enhanced Alternative" drug benefit. This plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a $5 copay for preferred generic drugs at preferred pharmacies and 25% coinsurance for standard generic drugs. For preferred brand drugs, you'll pay 50% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Complete Blue PPO Choice (PPO) plan offers a variety of benefits, including inpatient hospital care with a copay, outpatient services with copays ranging from $45 to $350, and ambulance services with a $250 copay. Emergency services have copays of $30 to $110, while primary care visits have copays between $15 and $45. Additional benefits include hearing and vision services, dental, and home health services with no copay. The plan also covers home infusion, dialysis, and medical equipment with coinsurance. There is also coverage for skilled nursing facilities with a copay after the initial 20 days.
Inpatient Hospital See details
The Complete Blue PPO Choice (PPO) plan covers inpatient hospital services, including acute and psychiatric care. For inpatient hospital-acute, there is a $170 copay for days 1-3, and no copay for days 4-90, while inpatient hospital psychiatric has a $425 copay for days 1-3, and no copay for days 4-90. Non-Medicare-covered stays, additional days for inpatient hospital psychiatric, and upgrades for inpatient hospital-acute are 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 and Observation Services have a $350 copay, ASC Services have a $250 copay, and Outpatient Substance Abuse Services have a $45 copay for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the Complete Blue PPO Choice (PPO) plan. There is no additional information about the cost of the benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including all ambulance services and transportation services to a plan-approved health-related location. Ground and air ambulance services have a $250 copay. 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 under the Complete Blue PPO Choice (PPO) plan. Emergency Services has a $110 copay, and Urgently Needed Services has a $30 copay, while Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
The Complete Blue PPO Choice (PPO) plan covers primary care physician services, chiropractic services (with a $15 copay), occupational therapy services (with a $25 copay), physician specialist services (with a $30 copay), mental health and psychiatric services (with a $40 copay), podiatry services (with a $30 copay), other health care professional services (with a copay between $0 and $30), physical therapy and speech-language pathology services (with a $25 copay), additional telehealth benefits (with a copay between $0 and $45), and opioid treatment program services (with a $45 copay). Routine chiropractic care is limited to 4 visits per year.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services, are covered by the Complete Blue PPO Choice (PPO) plan. Some services, such as Health Education, In-Home Safety Assessment, Counseling Services, and others, are not covered. Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) have a copay between $0 and $30, 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, with OTC hearing aids and fitting/evaluation for hearing aids not covered. Hearing exams have a $30 copay, while prescription hearing aids have a maximum benefit of $500 per year with a copay between $699-$999 depending on the type of aid.
Vision Services See details
Vision services include eye exams with a $30 copay, and eyewear with a combined maximum of $350 per year for both in-network and out-of-network services. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Complete Blue PPO Choice (PPO) plan covers dental services, including Medicare dental services with a $30 copay, and other dental services with a $3,500 annual maximum. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, along with restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with 50% coinsurance. The plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Complete Blue PPO Choice (PPO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%. Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Complete Blue PPO Choice (PPO) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
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 $250.00, Therapeutic Radiological Services have a copay of at most $75.00, and Outpatient X-Ray Services have a copay of $25.00.
Home Health Services See details
Home Health Services are covered by the Complete Blue PPO Choice (PPO) plan with no copay and no coinsurance, but prior 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 this plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is no copay or coinsurance for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Complete Blue PPO Choice (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 for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, but does not cover 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. The plan does provide Over-The-Counter (OTC) Items as a supplemental benefit under Part C, and there is no maximum plan benefit coverage amount.
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