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Complete Blue Plus PPO Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Complete Blue Plus 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 Plus PPO Choice (PPO) in 2025, please refer to our full plan details page.
Complete Blue Plus PPO Choice (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 (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 (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 (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:
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Drug Coverage
The Complete Blue Plus PPO Choice (PPO) plan has an "Enhanced Alternative" drug benefit. The plan has no deductible for prescription drugs. In the initial coverage phase, you'll pay a $5 copay for preferred generic drugs at a preferred pharmacy, and 25% coinsurance for standard generic drugs. For preferred brand drugs, you'll pay 50% coinsurance. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Complete Blue Plus PPO Choice (PPO) plan offers a wide range of benefits, including inpatient and outpatient hospital services, emergency care, and various specialist visits. You'll find copays for many services, such as $170 for inpatient hospital stays (days 1-3), $350 for outpatient services, and $15 for chiropractic services. This plan also provides coverage for preventive, hearing, vision, and dental services. Routine eye exams have a $30 copay, while dental services include a $30 copay for Medicare dental services and a $3,500 annual maximum benefit for other dental services. The plan also covers home health services with no copay, and includes benefits for medical equipment and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $170 copay for days 1-3 and no copay for days 4-90 for Inpatient Hospital-Acute, and a $425 copay for days 1-3 and no copay for days 4-90 for Inpatient Hospital Psychiatric. Additional days and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services and observation services with a $350 copay, ambulatory surgical center services with a $250 copay, outpatient substance abuse services with a $45 copay for both individual and group sessions, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Complete Blue Plus PPO Choice (PPO) plan. There is no information provided on the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Complete Blue Plus PPO Choice (PPO) plan. Ground and air ambulance services have a $250 copay, and there is no coinsurance. Transportation Services to a plan-approved health-related location are covered, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Complete Blue Plus PPO Choice (PPO) plan. Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a $30 copay and no coinsurance. 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 Plus 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, Podiatry Services with a $30 copay, Other Health Care Professional services with a copay between $0-$30, Psychiatric Services with a $40 copay, Physical Therapy and Speech-Language Pathology Services with a $25 copay, Additional Telehealth Benefits with a copay between $0-$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 include coverage for Medicare-covered services with no copay, annual physical exams, and additional preventive services. Additional preventive services may have a copay and coinsurance, and some sub-services such as health education, in-home safety assessments, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Routine hearing exams have a $20 copay, and you are allowed 1 exam per year. Prescription hearing aids have a maximum benefit of $500 every year, and the copay ranges from $699 to $999. 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 are covered, including routine eye exams with a $30 copay. Eyewear is covered with a combined maximum benefit of $350 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services include a $30 copay for Medicare dental services, and a $3,500 annual maximum benefit for other dental services. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, with limitations on the number of visits and periodicity. 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, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, but prior authorization is required. You will pay a $35 copay for Medicare Part B Insulin Drugs, and the coinsurance for all three services can range from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Complete Blue Plus PPO Choice (PPO) plan, with a coinsurance of 20%.
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 coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Complete Blue Plus PPO Choice (PPO) plan, though 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 $25 copay.
Home Health Services See details
Home Health Services are covered by the Complete Blue Plus 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
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 Plus PPO Choice (PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Other Services includes coverage for over-the-counter (OTC) items, while acupuncture, meal benefits, and other services are not covered. The plan does not offer nicotine replacement therapy or Naloxone coverage as a Part C OTC benefit, and does not cover all drugs on the CMS OTC list.
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