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Community Blue Medicare Plus PPO Signature (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community Blue Medicare Plus PPO Signature (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Community Blue Medicare Plus PPO Signature (PPO) in 2026, please refer to our full plan details page.
Community Blue Medicare Plus PPO Signature (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2026 to people living in Clinton, PA. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Community Blue Medicare Plus 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 Community Blue Medicare Plus 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 Community Blue Medicare Plus 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 $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 Community Blue Medicare Plus PPO Signature (PPO) plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for 1-month or 3-month supplies at preferred pharmacies, nor for 3-month supplies filled through preferred mail order. Tier 2 generic medications cost a low $3 copay for a 1-month supply at preferred pharmacies, whereas standard pharmacies charge a $15 copay. For brand-name and specialty medications, this plan utilizes coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 23% coinsurance at both preferred and standard pharmacies. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance for all available supply options.
Additional Benefits
The Community Blue Medicare Plus PPO Signature (PPO) plan offers robust medical coverage with no copay for primary care visits, while specialist visits require a $50 copay. For hospital stays, members pay a $270 daily copay for the first 10 days of acute inpatient care, with no coinsurance required. Emergency room visits carry a $115 copay, which is waived if admitted, and urgent care is available for a $40 copay. This plan also includes key ancillary benefits, featuring no copay for preventive dental care and a $350 annual allowance for eyewear with no copay. Additionally, members can access routine hearing exams for a $25 copay and receive a $30 quarterly allowance for over-the-counter items. While home health services require no copay or coinsurance, durable medical equipment and dialysis services carry a 20% coinsurance.
Inpatient Hospital See details
Community Blue Medicare Plus PPO Signature (PPO) covers inpatient hospital services with no coinsurance, requiring a $270 copay per day for days 1 to 10 of acute stays and a $425 copay per day for days 1 to 3 of psychiatric stays, with no copay for remaining covered days. The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Community Blue Medicare Plus PPO Signature (PPO) with no coinsurance, featuring a $450 copay for outpatient hospital and observation services, and a $400 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $45 copay, while outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Community Blue Medicare Plus PPO Signature (PPO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Community Blue Medicare Plus PPO Signature (PPO) covers ground and air ambulance services with a $315 copay and no coinsurance. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Community Blue Medicare Plus PPO Signature (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within three days, and urgently needed services with a $40 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $115, $40, and $315, respectively.
Primary Care See details
Community Blue Medicare Plus PPO Signature (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Other services like physical therapy, mental health, and podiatry have copays ranging from $0 to $50 with no coinsurance, though chiropractic care is only partially covered because other chiropractic services are excluded.
Preventive Services See details
Community Blue Medicare Plus PPO Signature (PPO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering remote access technologies with a copay of $0 to $50 and no coinsurance, and home safety devices with a 20% coinsurance and no copay, while excluding health education, personal emergency response systems, and weight management programs.
Hearing Services See details
Hearing services are partially covered by Community Blue Medicare Plus PPO Signature (PPO), which offers one routine hearing exam annually for a $25 copay and no coinsurance. Up to two prescription hearing aids are covered per year with copays ranging from $699 to $999 and no coinsurance under a $500 annual limit, though hearing aid fittings, OTC hearing aids, and inner, outer, or over-the-ear models are not covered.
Vision Services See details
Community Blue Medicare Plus PPO Signature (PPO) partially covers vision services, including one routine eye exam per year with a $50 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, including contact lenses, eyeglasses, and upgrades, has no copay and no coinsurance up to a combined annual maximum of $350.
Dental Services See details
Community Blue Medicare Plus PPO Signature (PPO) partially covers dental services up to a $2,000 annual maximum, offering preventive care with no copay or coinsurance, Medicare-covered services for a $50 copay and no coinsurance, and comprehensive services with no copay and 50% coinsurance (0% to 50% for adjunctive services). Implants, orthodontics, maxillofacial prosthetics, other diagnostic dental, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Community Blue Medicare Plus PPO Signature (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Community Blue Medicare Plus PPO Signature (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Community Blue Medicare Plus PPO Signature (PPO) with no copays, though prior authorization is required for these services. Patients will pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic shoes, while diabetic supplies require between no coinsurance and 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Community Blue Medicare Plus PPO Signature (PPO) with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic tests range from a $0 to $10 copay, outpatient X-rays require a $20 copay, and therapeutic and diagnostic radiology services carry minimum copays of $60 and $350, respectively.
Home Health Services See details
Home Health Services are covered by Community Blue Medicare Plus PPO Signature (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Community Blue Medicare Plus PPO Signature (PPO) plan. In practice, the plan does not cover cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, or SET for PAD services.
Skilled Nursing Facility (SNF) See details
Community Blue Medicare Plus PPO Signature (PPO) covers skilled nursing facility (SNF) care with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not needed, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Community Blue Medicare Plus PPO Signature (PPO) partially covers other services, offering a $30 allowance every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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