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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 2025 to people living in West Virginia. This plan received an overall rating of 3.5 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. Additionally, this plan comes with a Part B Premium reduction of $4.00. 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 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 Complete Blue PPO Signature (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay for a 1-month or 3-month supply when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail order, Tier 1 drugs cost a $7 copay for a 1-month supply ($21 for 3 months), while Tier 2 drugs carry a $15 copay for 1 month ($45 for 3 months). For higher-tier medications, costs transition to coinsurance instead of copays. Tier 3 preferred brands require a 19% coinsurance, and Tier 4 non-preferred drugs have a 20% coinsurance, regardless of whether you use preferred or standard pharmacies and mail-order services. Specialty drugs in Tier 5 carry a 25% coinsurance for a 1-month supply across all pharmacy and mail-order options.
Additional Benefits
The Complete Blue PPO Signature (PPO) plan offers robust coverage with no copay for primary care visits, preventive services, and home health care. For specialized medical needs, members pay a $35 copay for specialist visits, while emergency room visits incur a $115 copay. Inpatient hospital stays require a $275 daily copay for the first five days, after which there is no copay, and outpatient hospital services carry a $300 copay. The plan also features strong supplemental benefits, including preventive dental care with no copay and comprehensive dental up to a $2,000 annual limit with a 20% coinsurance. Vision services feature no copay for eyewear up to a $350 annual allowance, and members receive a $120 allowance every three months for over-the-counter items. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay, helping keep out-of-pocket costs predictable.
Inpatient Hospital See details
Complete Blue PPO Signature (PPO) partially covers inpatient hospital services with no coinsurance, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute hospital stays require a $275 daily copay for days 1 to 5 followed by no copay, while psychiatric stays require a $425 daily copay for days 1 to 3 followed by no copay for days 4 to 90.
Outpatient Services See details
Complete Blue PPO Signature (PPO) covers outpatient services with no coinsurance, including a $300 copay for outpatient hospital and daily observation services, and a $250 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Complete Blue PPO Signature (PPO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Complete Blue PPO Signature (PPO) covers ground and air ambulance services with a $200 copay and no coinsurance. Transportation services are partially covered with no copay and no coinsurance for unlimited one-way trips to plan-approved locations, but transportation to any other health-related locations is not covered.
Emergency Services See details
Complete Blue PPO Signature (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within three days. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $115, $40, and $200 respectively.
Primary Care See details
Complete Blue PPO Signature (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance for routine care, though other chiropractic services are not covered, while therapy, mental health, and podiatry services feature copays from $30 to $40 and no coinsurance.
Preventive Services See details
Complete Blue PPO Signature (PPO) provides annual physical exams, kidney disease education, and other preventive services with no copay and no coinsurance. Additional preventive benefits are partially covered, featuring remote access technologies with a $0 to $35 copay and home safety devices with 20% coinsurance, while excluding health education, PERS, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, and counseling.
Hearing Services See details
Complete Blue PPO Signature (PPO) provides partially covered hearing services, featuring one annual routine hearing exam with a $25 to $35 copay and no coinsurance, though fitting and evaluation exams are not covered. Prescription hearing aids are covered up to a $500 annual limit with copays between $699 and $999 and no coinsurance, but OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Complete Blue PPO Signature (PPO), which features a $35 copay and no coinsurance for one routine annual eye exam, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing up to a $350 combined annual maximum for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are covered under the Complete Blue PPO Signature (PPO) up to a $2,000 annual limit, featuring no copay or coinsurance for preventive care like cleanings and exams. Medicare-covered dental services require a $35 copay and no coinsurance, while comprehensive services require no copay and a 20% coinsurance, though implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Complete Blue PPO Signature (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and a coinsurance of no coinsurance to 20%.
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, including durable medical equipment, prosthetics, and diabetic therapeutic shoes, with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay and coinsurance ranging from 0% to 20%, subject to manufacturer limitations and prior authorization.
Diagnostic and Radiological Services See details
Complete Blue PPO Signature (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Members pay no copay for lab services, up to a $10 copay for diagnostic tests, a $25 copay for X-rays, and minimum copays of $60 for therapeutic radiology and $250 for diagnostic radiology.
Home Health Services See details
Complete Blue PPO Signature (PPO) covers Home Health Services 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. This exclusion applies to all related sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Complete Blue PPO Signature (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required and no prior three-day hospital stay is needed, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Complete Blue PPO Signature (PPO), featuring over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $120 every three months. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this benefit.
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