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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 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 $6.00. 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 Generic) and Tier 2 (Generic) medications, you pay no copay when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order services charge a $7 copay for Tier 1 drugs and a $15 copay for Tier 2 drugs for a 1-month supply. Higher-tier medications require coinsurance rather than flat copayments. You will pay 19% coinsurance for Tier 3 (Preferred Brand) drugs and 20% coinsurance for Tier 4 (Non-Preferred) drugs, regardless of whether you use preferred or standard pharmacy services. Tier 5 (Specialty Tier) drugs require 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 medical coverage with predictable cost-sharing, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For hospital stays, members pay a daily copay of $315 for days 1 to 5 of acute inpatient stays and $300 for outpatient hospital services, both with no coinsurance. Emergency care is available with a $115 copay, which is waived if admitted, while specialist visits require a $40 copay. Supplemental benefits include dental care with no copay for preventive services and a 20% coinsurance for comprehensive services up to a $2,000 annual limit. Vision and hearing benefits are also covered, featuring no copay for eyewear up to a $350 annual limit and prescription hearing aid copays ranging from $699 to $999. Additionally, members can access over-the-counter items with no copay and no coinsurance up to $120 every three months.
Inpatient Hospital See details
Complete Blue PPO Signature (PPO) covers inpatient hospital services with no coinsurance, requiring a $315 daily copay for days 1-5 of acute stays and a $425 daily copay for days 1-3 of psychiatric stays, with no copays for subsequent days. This benefit is partially covered because upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Complete Blue PPO Signature (PPO) with no coinsurance, featuring 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, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the Complete Blue PPO Signature (PPO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Complete Blue PPO Signature (PPO) partially covers Ambulance and Transportation Services, featuring a $200 copay and no coinsurance for both ground and air ambulance services. Unlimited one-way transportation to plan-approved health-related locations is available with no copay and no coinsurance, though transportation to any other 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 urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with copays of $115, $40, and $200 respectively, and no coinsurance.
Primary Care See details
Complete Blue PPO Signature (PPO) provides primary care physician services with no copay and no coinsurance, while specialist, psychiatric, and podiatry visits require a $40 copay and no coinsurance. Physical therapy has a $30 copay with no coinsurance, and chiropractic benefits are partially covered, offering up to 8 routine visits for a $15 copay and no coinsurance while excluding other chiropractic services.
Preventive Services See details
Complete Blue PPO Signature (PPO) covers preventive services, offering annual physical exams, kidney disease education, and other preventive screenings with no copay and no coinsurance. This benefit is partially covered, as remote access technologies require a $0 to $40 copay and home safety devices have a 20% coinsurance, while health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation counseling, telemonitoring, and counseling services are not covered.
Hearing Services See details
Complete Blue PPO Signature (PPO) partially covers hearing services, offering one routine hearing exam annually with a $25 copay and no coinsurance, though fitting and evaluation services are not covered. Prescription hearing aids are covered up to two times per year with a copay between $699 and $999 and no coinsurance, subject to a $500 annual limit, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Complete Blue PPO Signature (PPO) covers vision services, offering one routine eye exam per year with a $40 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear, including contacts, frames, lenses, and upgrades, has no copay or coinsurance up to a $350 combined annual limit.
Dental Services See details
Complete Blue PPO Signature (PPO) offers partially covered dental services with a combined $2,000 annual maximum, featuring a $40 copay and no coinsurance for Medicare dental services, and no copay and no coinsurance for preventive care. Covered comprehensive services require no copay and a 20% coinsurance (0% to 20% for adjunctive services), while other diagnostic, other preventive, 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 is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
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 durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and generally a 20% coinsurance, though diabetic supplies range from no coinsurance to 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Complete Blue PPO Signature (PPO) with no coinsurance, subject to prior authorization. Lab services feature no copay, diagnostic procedures range from no copay to a $10 copay, outpatient x-rays cost $25, and therapeutic and diagnostic radiological services require minimum copays of $60 and $250, respectively.
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 covered by the Complete Blue PPO Signature (PPO) with no copay and no coinsurance, although only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Complete Blue PPO Signature (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Complete Blue PPO Signature (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $120 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone coverage are not covered.
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