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Complete Blue PPO Signature (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Complete Blue PPO Signature (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 Signature (PPO) in 2026, please refer to our full plan details page.
Complete Blue PPO Signature (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2026 to people living in WPA 9 counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Complete Blue PPO Signature (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 Signature (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 Signature (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.
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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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 Signature (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at a preferred pharmacy, as well as no copay for a 3-month preferred mail-order supply. Tier 2 generic medications are also highly affordable, starting at a low $3 copay for a 1-month supply at preferred pharmacies. For higher-tier medications, costs transition to a percentage of the drug's price. Tier 3 preferred brand drugs require a 23% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. These coinsurance rates apply across preferred and standard pharmacies as well as mail-order services.
Additional Benefits
The Complete Blue PPO Signature (PPO) plan offers robust medical coverage with no copay for primary care visits, preventive services, and home health care. Outpatient hospital services, specialists, and emergency care are covered with flat copayments and no coinsurance, while inpatient hospital stays require a daily copay for the first several days before transitioning to no copay. This plan also includes key supplemental benefits like dental coverage up to a $1,500 annual limit, a $400 yearly eyewear allowance with no copay, and unlimited rides to plan-approved locations with no copay. Additionally, members benefit from routine hearing exams, prescription hearing aid options, and a quarterly $25 allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Complete Blue PPO Signature (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered. For acute inpatient stays, you will pay a $275 daily copay for days 1-7 and no copay for days 8 and beyond. Psychiatric inpatient stays require a $425 daily copay for days 1-3, with no copay for days 4-90.
Outpatient Services See details
Outpatient services are covered by Complete Blue PPO Signature (PPO) with no coinsurance, requiring a $375 copay for outpatient hospital and daily observation services, and a $325 copay for ambulatory surgical center services. Outpatient substance abuse services carry a $45 copay with no coinsurance, while outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Complete Blue PPO Signature (PPO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Complete Blue PPO Signature (PPO) covers ambulance services with a $430 copay and no coinsurance for ground and air transport. Transportation services are partially covered, offering unlimited rides to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Complete Blue PPO Signature (PPO) covers emergency services with a $115 copay (waived if admitted within 3 days) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency services are also covered with no coinsurance, requiring a $115 copay for emergency care, a $40 copay for urgent care, and a $430 copay for emergency transportation. None of these emergency or urgent care costs count toward the plan-level deductible.
Primary Care See details
Primary care benefits under the Complete Blue PPO Signature (PPO) feature no copay and no coinsurance for primary care doctor visits, while specialist, physical therapy, and podiatry visits require a $50 copay with no coinsurance. Other services include occupational therapy with a $35 copay, mental health and psychiatric sessions with a $40 copay, and telehealth with no copay to a $50 copay, all with no coinsurance. Chiropractic benefits are partially covered, offering routine care for a $15 copay with no coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Complete Blue PPO Signature (PPO) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training with no copay and no coinsurance. Additional preventive benefits are partially covered, featuring a $0 to $50 copay for remote access technologies and 20% coinsurance for home safety devices, though services like health education, personal emergency response systems (PERS), nutritional benefits, and in-home support are not covered.
Hearing Services See details
Complete Blue PPO Signature (PPO) partially covers hearing services, offering routine exams with a $20 copay and prescription hearing aids with a $699 to $999 copay up to a $500 annual maximum, both with no coinsurance. Fitting and evaluation exams, OTC hearing aids, and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Complete Blue PPO Signature (PPO), which features one annual routine eye exam for a $50 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a combined maximum plan benefit of $400 per year for contacts, eyeglasses, and upgrades.
Dental Services See details
Complete Blue PPO Signature (PPO) provides partially covered dental services up to a $1,500 annual limit, excluding other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics. Medicare-covered dental has a $50 copay and no coinsurance, while covered preventive services have no copay and no coinsurance, and covered comprehensive services have no copay and 50% coinsurance (0% to 50% coinsurance for adjunctive services).
Home Infusion bundled Services See details
Complete Blue PPO Signature (PPO) covers home infusion bundled services with no copay, requiring prior authorization and step therapy. Covered Medicare Part B chemotherapy and other drugs feature no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay, no coinsurance to 20% coinsurance, and does not apply to the plan deductible.
Dialysis Services See details
Dialysis Services are covered under the Complete Blue PPO Signature (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Complete Blue PPO Signature (PPO) covers medical equipment, prosthetics, and diabetic supplies with no copay and a 20% coinsurance, while diabetic supplies range from no coinsurance to 20% coinsurance. Prior authorization is required for these covered benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services under the Complete Blue PPO Signature (PPO) are covered with no coinsurance, subject to prior authorization. Lab services have no copay, diagnostic tests carry a $0 to $10 copay, outpatient X-rays require a $20 copay, and therapeutic and diagnostic radiological services have copays starting at $60 and $350, respectively.
Home Health Services See details
Home health services are covered under the Complete Blue PPO Signature (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Complete Blue PPO Signature (PPO) plan, as standard, intensive, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Complete Blue PPO Signature (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
Other services are partially covered by Complete Blue PPO Signature (PPO), which excludes acupuncture and meal benefits. However, over-the-counter (OTC) items are covered with no copay and no coinsurance, providing a maximum benefit of $25 every three months.
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