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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 $5.00. 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 has an annual prescription drug deductible of $615. You will pay no copay for Tier 1 preferred generic and Tier 2 generic medications when using a preferred pharmacy or preferred mail-order service. Standard pharmacies charge a $7 copay for Tier 1 and a $15 copay for Tier 2 on a 1-month supply. For brand-name and specialty prescriptions, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands require a 19% coinsurance and Tier 4 non-preferred drugs require a 20% coinsurance at both preferred and standard pharmacies. Tier 5 specialty medications 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 comprehensive medical coverage featuring no copay and no coinsurance for primary care visits and preventive services. For specialized care, members pay a predictable $35 copay for specialist visits and a $115 copay for emergency room services. Inpatient hospital stays require daily copays for the first few days but feature no coinsurance, while outpatient services and skilled nursing facility care are covered with minimal out-of-pocket costs. Beyond standard medical care, this plan provides robust dental, vision, and hearing benefits, including preventive dental care with no copay and up to a $2,000 annual limit for comprehensive dental services. Routine eye and hearing exams require a $35 copay, with additional allowances of up to $350 annually for eyewear and coverage for prescription hearing aids. Members also benefit from home health services with no copay or coinsurance and a $105 quarterly allowance for over-the-counter products.
Inpatient Hospital See details
Inpatient Hospital care is covered by Complete Blue PPO Signature (PPO) with no coinsurance, requiring a $275 daily copay for days 1 through 5 of acute stays and a $425 daily copay for days 1 through 3 of psychiatric stays, with no copay for remaining covered days. Hospital upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered.
Outpatient Services See details
Complete Blue PPO Signature (PPO) covers outpatient services with no coinsurance, including outpatient hospital and daily observation services for a $300 copay, and ambulatory surgical center services for a $250 copay. Outpatient substance abuse sessions require a $40 copay, while outpatient blood services are available with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Complete Blue PPO Signature (PPO) covers partial hospitalization with no copay and no coinsurance. This ensures you can access these covered services without any out-of-pocket costs for copayments or coinsurance.
Ambulance and Transportation Services See details
Complete Blue PPO Signature (PPO) covers ambulance services with a $200 copay and no coinsurance for both ground and air transportation. Transportation services are partially covered with no copay and no coinsurance for unlimited trips to plan-approved locations, but 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, which is waived if admitted to the hospital within three days, and urgent care with a $40 copay, both with no coinsurance. Worldwide emergency services are also covered with no coinsurance, featuring a $115 copay for emergency care, a $40 copay for urgent care, and a $200 copay for emergency transportation.
Primary Care See details
Complete Blue PPO Signature (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Additional services like physical therapy, mental health, and podiatry feature copays ranging from $30 to $40 with no coinsurance, though chiropractic care is only partially covered because 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 screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, featuring remote access technologies with a copay of $0 (no copay) to $35 and no coinsurance, and home safety devices with a 20% coinsurance and no copay, while health education, in-home safety assessments, PERS, 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 are not covered.
Hearing Services See details
Hearing services are covered by Complete Blue PPO Signature (PPO), featuring routine hearing exams with a $35 copay and no coinsurance, though fitting evaluations and OTC hearing aids are not covered. Prescription hearing aids are covered with no coinsurance and copays ranging from $699 to $999 up to a $500 annual maximum, although inner, outer, and over-the-ear devices are excluded.
Vision Services See details
Complete Blue PPO Signature (PPO) partially covers vision services, offering one routine eye exam per year with a $35 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing up to a $350 annual maximum benefit for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Complete Blue PPO Signature (PPO) up to a $2,000 annual limit, offering preventive care with no copay and no coinsurance, and Medicare-covered dental for a $35 copay and no coinsurance. Most comprehensive services require no copay and 20% coinsurance, but other diagnostic and preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Complete Blue PPO Signature (PPO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Complete Blue PPO Signature (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Complete Blue PPO Signature (PPO) covers medical equipment with no copay, though prior authorization is required for these services. Durable medical equipment, prosthetics, medical supplies, and diabetic shoes or inserts require a 20% coinsurance, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Complete Blue PPO Signature (PPO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. Diagnostic tests range from no copay to a $10 copay, lab services have no copay, and radiological services carry a $25 copay for X-rays, a minimum $60 copay for therapeutic services, and a minimum $250 copay for diagnostic radiology.
Home Health Services See details
Home Health Services are covered by Complete Blue PPO Signature (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Complete Blue PPO Signature (PPO) does not cover cardiac rehabilitation services. This includes standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services, which 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, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a three-day prior hospital stay is not necessary, 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), which excludes acupuncture and meal benefits but covers over-the-counter (OTC) items. Covered OTC items have no copay and no coinsurance, up to a maximum benefit limit of $105 every three months.
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