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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 North and South WV 15 Counties. 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.
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 Complete Blue PPO Signature (PPO) medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at a preferred pharmacy or through preferred mail order, while standard pharmacies charge a $7 copay for a 1-month supply. Tier 2 generic drugs cost a low $3 copay for a 1-month supply at preferred pharmacies, compared to a $15 copay at standard pharmacies. For higher-tier medications, you will pay coinsurance rather than flat copays, including 22% coinsurance for Tier 3 preferred brand drugs. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance across all pharmacy options. Utilizing preferred pharmacies and preferred mail-order services provides the greatest cost savings on your prescriptions under this plan.
Additional Benefits
The Complete Blue PPO Signature (PPO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, while specialist visits require a $45 copay. Inpatient hospital stays feature a $335 daily copay for the first five days with no copay thereafter, and outpatient services carry a $350 copay. Emergency room visits have a $115 copay, which is waived if you are admitted to the hospital within three days. For ancillary care, the plan features preventive dental and annual physical exams with no copay, plus up to a $2,000 annual maximum for covered dental services. Routine eye exams require a $45 copay, but eyewear is covered with no copay up to a $350 annual limit. Additionally, medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Complete Blue PPO Signature (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $335 copay per day for days 1 to 5 and no copay for days 6 and beyond, while psychiatric stays require a $425 copay per day for days 1 to 3 and no copay for days 4 to 90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Complete Blue PPO Signature (PPO) covers outpatient hospital and observation services for a $350 copay, and ambulatory surgical center services for a $300 copay, with no coinsurance. Outpatient substance abuse sessions require a $40 copay and no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization is covered by the Complete Blue PPO Signature (PPO) plan 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 $560 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, but 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 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 of $115, $40, and $560, 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 $45 copay and no coinsurance. Other services are partially covered, featuring routine chiropractic care with a $15 copay and no coinsurance (other chiropractic services are not covered), while physical therapy, occupational therapy, and mental health services carry copays ranging from $30 to $40 with no coinsurance.
Preventive Services See details
Complete Blue PPO Signature (PPO) offers partially covered preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, and other preventive screenings. While remote access technologies carry a $0 to $45 copay and home safety devices require a 20% coinsurance, uncovered services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for chemotherapy-related hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking and tobacco cessation counseling, telemonitoring, and counseling.
Hearing Services See details
Hearing services are partially covered by Complete Blue PPO Signature (PPO) with no coinsurance and no deductibles. Routine hearing exams have a $25 copay (one per year), other hearing exams have a $45 copay, and prescription hearing aids have a $699 to $999 copay with a $500 annual coverage limit. Fitting and evaluation, OTC hearing aids, and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Complete Blue PPO Signature (PPO) offers partially covered vision services, with other eye exam services not covered. Routine eye exams require a $45 copay and no coinsurance with no deductible, while eyewear has no copay, no coinsurance, and no deductible up to a combined annual maximum of $350.
Dental Services See details
Complete Blue PPO Signature (PPO) offers partially covered dental services with a combined annual maximum of $2,000, excluding other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics. Medicare-covered dental has a $45 copay and no coinsurance, while covered preventive services have no copay and no coinsurance, and covered comprehensive services have no copay and 50% coinsurance (0% to 50% coinsurance for adjunctive services).
Home Infusion bundled Services See details
Home infusion bundled services are covered by Complete Blue PPO Signature (PPO) with no copay, though prior authorization and step therapy may apply. Associated Medicare Part B drugs, including chemotherapy, radiation, and other drugs, require no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and up to 20% coinsurance.
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 supplies, with no copay and a 20% coinsurance, though diabetic supplies range from no coinsurance to 20% coinsurance. Prior authorization is required for these covered benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services under Complete Blue PPO Signature (PPO) are covered with no coinsurance, though prior authorization is required. Members pay no copay for lab services, a $0 to $10 copay for diagnostic procedures and tests, a $25 copay for outpatient X-rays, and minimum copays of $60 for therapeutic radiological services and $300 for diagnostic radiological services.
Home Health Services See details
Home Health Services are covered by the Complete Blue PPO Signature (PPO) plan 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, including intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services.
Skilled Nursing Facility (SNF) See details
Complete Blue PPO Signature (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement. There is no copay for days 1 through 20, while days 21 through 100 require a $218 daily copay, and additional days beyond the 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 $25 every three months. Acupuncture, meal benefits, and other supplemental services under this category are not covered.
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