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Community Blue Medicare PPO Signature (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community Blue Medicare 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 PPO Signature (PPO) in 2026, please refer to our full plan details page.
Community Blue Medicare PPO Signature (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2026 to people living in Rural Eastern 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 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 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 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 PPO Signature (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies or through preferred mail order. Tier 2 generic drugs cost as little as a $3 copay for a 1-month supply at a preferred pharmacy, while standard pharmacies charge a $15 copay. For higher-tier medications, the plan transitions from flat copays to coinsurance. Tier 3 preferred brand drugs require a 23% coinsurance across all pharmacy types for both 1-month and 3-month supplies. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, helping you plan your healthcare expenses accordingly.
Additional Benefits
The Community Blue Medicare PPO Signature (PPO) plan offers comprehensive medical coverage featuring no copay for primary care visits and a $50 copay for specialist appointments. Medicare-covered preventive care, home health services, and cardiac rehabilitation are also covered with no copay or coinsurance. For hospital care, members pay a $270 daily copay for the first 10 days of an acute inpatient stay, while outpatient surgeries require a $400 to $450 copay. Additional benefits include preventive dental care with no copay up to a $2,000 annual maximum, and a $350 yearly allowance for eyewear. Routine hearing exams require a $25 copay, with prescription hearing aids covered at copays between $699 and $999. Durable medical equipment, medical supplies, and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Community Blue Medicare PPO Signature (PPO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $270 for days 1-10 of acute stays (no copay for days 11 and beyond) and $425 for days 1-3 of psychiatric stays (no copay for days 4-90). This benefit is partially covered, as prior authorization is required, and upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Community Blue Medicare PPO Signature (PPO) covers outpatient hospital and observation services with a $450 copay and no coinsurance, and ambulatory surgical center services with a $400 copay and no coinsurance. Outpatient substance abuse services require a $45 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Community Blue Medicare PPO Signature (PPO) covers partial hospitalization services with no copay and no coinsurance. Eligible members can access these structured outpatient program benefits without any copayment or coinsurance costs.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Community Blue Medicare PPO Signature (PPO) plan, with ground and air ambulance services requiring a $405 copay and no coinsurance. Transportation services are partially covered, offering unlimited rides to plan-approved health-related locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
Community Blue Medicare PPO Signature (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services have a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $40 to $405.
Primary Care See details
Community Blue Medicare PPO Signature (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $50 copay and no coinsurance. Additional services like therapy, mental health, and podiatry feature no coinsurance and copays ranging from $0 to $50, though chiropractic care is only partially covered as other chiropractic services are not covered.
Preventive Services See details
Community Blue Medicare PPO Signature (PPO) offers Medicare-covered preventive services, annual physical exams, and kidney disease education with no copay and no coinsurance. Additional preventive benefits are partially covered, featuring memory fitness, remote access technologies with a $0 to $50 copay, and home safety devices with 20% coinsurance, though services like health education, nutritional counseling, and personal emergency response systems are not covered.
Hearing Services See details
Community Blue Medicare PPO Signature (PPO) partially covers hearing services, offering one routine hearing exam per year with a $25 copay and no coinsurance, while fitting and evaluation exams are not covered. Up to two prescription hearing aids are covered per year with a copay ranging from $699 to $999, no coinsurance, and a $500 annual benefit limit, but OTC hearing aids and inner, outer, or over-the-ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by Community Blue Medicare PPO Signature (PPO), offering one routine eye exam per year with a $50 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a combined annual limit of $350 for contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered under Community Blue Medicare PPO Signature (PPO) with an annual maximum benefit of $2,000. Medicare-covered dental has a $50 copay and no coinsurance, while preventive services like exams and cleanings have no copay and no coinsurance, and comprehensive services carry no copay and 50% coinsurance. Other diagnostic or preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Community Blue Medicare PPO Signature (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Community Blue Medicare PPO Signature (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Community Blue Medicare PPO Signature (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment and supplies are also covered with no copay and a coinsurance ranging from no coinsurance up to 20%, though manufacturer limitations apply.
Diagnostic and Radiological Services See details
Community Blue Medicare PPO Signature (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Diagnostic lab services have no copay, while other diagnostic procedures range from a $0 to $10 copay, outpatient X-rays require a $20 copay, and diagnostic and therapeutic radiological services have minimum copays of $350 and $60, respectively.
Home Health Services See details
Home health services are covered under the Community Blue Medicare PPO Signature (PPO) plan with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Community Blue Medicare PPO Signature (PPO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, but only some services are covered as Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Community Blue Medicare PPO Signature (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 copay for days 21 through 100. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, and prior authorization is required.
Other Services See details
Community Blue Medicare PPO Signature (PPO) partially covers other services, featuring over-the-counter (OTC) items with no copay and no coinsurance up to $30 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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