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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 no deductible for prescription drugs. In 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. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Complete Blue PPO Choice (PPO) plan offers a wide range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. It also covers ambulance and transportation services, emergency services, and primary care physician visits. The plan provides coverage for preventive, hearing, vision, and dental services, with specific copays and annual maximums. Additional benefits include home health services, skilled nursing facility stays, and medical equipment, with some services subject to coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered by the Complete Blue PPO Choice (PPO) plan, with a copay of $170 for days 1-3 and no copay for days 4-90 for Inpatient Hospital-Acute, and a copay of $425 for days 1-3 and no copay for days 4-90 for Inpatient Hospital Psychiatric. Additional days and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a $350 copay, observation services with a $350 copay, ambulatory surgical center services with a $250 copay, individual and group sessions for outpatient substance abuse with a $45 copay, and outpatient blood services. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization benefits are covered with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Complete Blue PPO Choice (PPO) plan. Ground and air ambulance services have a $250 copay, while transportation services to a plan-approved health-related location are covered with no copay or coinsurance, 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 (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $30 copay, Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a $250 copay; all services have no coinsurance.
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 specialty services (with a $40 copay for individual and group sessions), podiatry services (with a $30 copay for routine foot care), other healthcare professional services (with a copay from $0-$30), psychiatric services (with a $40 copay for individual and group sessions), physical therapy and speech-language pathology services (with a $25 copay), additional telehealth benefits (with a copay from $0-$45), and opioid treatment program services (with a $45 copay). Chiropractic services, occupational therapy services, physical therapy and speech-language pathology services require prior authorization.
Preventive Services See details
The Complete Blue PPO Choice (PPO) plan covers various preventive services, including annual physical exams and other preventive services, with no copay or coinsurance for many services. Some services, like home and bathroom safety devices and modifications, have a 20% coinsurance, and remote access technologies have a copay between $0 and $30. Several services, such as health education and counseling, are not covered.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Hearing exams have a $30 copay, while prescription hearing aids are covered up to $500 per year and have a copay between $699 and $999, depending on the type. Fitting/Evaluation for Hearing Aid, 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 $30 copay, and eyewear with a combined maximum benefit of $350 every year. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, with a $30 copay for Medicare Dental Services. Other Dental Services are covered up to a $3,500 annual maximum, including oral exams (1 visit every six months), dental x-rays (1 per year), prophylaxis (cleaning) (1 visit every six months), and fluoride treatment (1 visit every six months). Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with 50% coinsurance, while Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay, and a coinsurance between 0-20%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Complete Blue PPO Choice (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment. 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. For Diagnostic Radiological Services, there is a copay of up to $250, for Therapeutic Radiological Services, the copay is up to $75, and for Outpatient X-Ray Services the copay is $25.
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 additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Complete Blue PPO Choice (PPO) 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 (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 include Over-the-Counter (OTC) Items, but acupuncture, meal benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered. Additionally, 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.
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