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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 Delaware. This plan received an overall rating of 4 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 drug coverage features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at preferred pharmacies, or for a 3-month supply through preferred mail order. Tier 2 generic medications are also highly affordable, with a low $3 copay for a 1-month supply at a preferred pharmacy. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require 21% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry 25% coinsurance. These coinsurance rates apply consistently across preferred and standard pharmacies, as well as mail-order services.
Additional Benefits
The Complete Blue PPO Signature (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care visits and preventive services, while specialist visits require a $50 copay. For hospital stays, inpatient services carry a daily copay of $375 for the first seven days, and outpatient hospital services require a $350 copay. Emergency room visits have a $130 copay, which is waived if you are admitted, and urgent care services are available for a $50 copay. Additional benefits include routine dental care with no copay, comprehensive dental coverage up to a $1,000 annual limit with 50% coinsurance, and a $350 annual allowance for eyewear with no copay. Routine hearing exams are available for a $30 copay, and prescription hearing aids are covered with copays ranging from $699 to $999. The plan also covers home health services with no copay and provides a $25 quarterly allowance for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Complete Blue PPO Signature (PPO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for stays. Acute stays cost a $375 daily copay for days 1 to 7 and no copay thereafter, while psychiatric stays require a $425 daily copay for days 1 to 3 and no copay for days 4 to 90; 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 with a $350 copay and no coinsurance, and ambulatory surgical center services with a $300 copay and no coinsurance. Outpatient substance abuse services require a $40 copay and no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
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 $505 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are covered under the Complete Blue PPO Signature (PPO) with a $130 copay (waived if admitted to the hospital within three days) and no coinsurance, while urgently needed services require a $50 copay and no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered with no coinsurance and copays of $130, $50, and $505 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 $50 copay and no coinsurance. Therapy, psychiatric, and podiatry services require copays ranging from $40 to $50 with no coinsurance, while chiropractic services are partially covered, excluding other chiropractic services but offering routine care for a $15 copay.
Preventive Services See details
Complete Blue PPO Signature (PPO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional benefits are partially covered, including memory fitness, remote access technologies (with a $0 to $50 copay), and safety devices (with 20% coinsurance), though services like health education, personal emergency response systems, and nutritional/dietary benefits are not covered.
Hearing Services See details
Hearing services are partially covered by Complete Blue PPO Signature (PPO), featuring one annual routine hearing exam with a $30 copay and no coinsurance, though fitting and evaluation exams are not covered. Prescription hearing aids are also partially covered with a $699 to $999 copay, no coinsurance, and a $500 annual limit, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services covered under the Complete Blue PPO Signature (PPO) plan include one annual routine eye exam for a $50 copay and no coinsurance, with no deductible, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a combined annual maximum of $350 for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Complete Blue PPO Signature (PPO) up to a $1,000 annual maximum, though other diagnostic or preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered. Medicare-covered dental requires a $50 copay and no coinsurance, while preventive care has no copay and no coinsurance, and covered comprehensive services have no copay and 50% coinsurance (0% to 50% for adjunctive services).
Home Infusion bundled Services See details
Home infusion bundled services are covered by Complete Blue PPO Signature (PPO) with no copay, requiring prior authorization. Medicare Part B chemotherapy, radiation, and other drugs have no copay and up 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 by Complete Blue PPO Signature (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Complete Blue PPO Signature (PPO) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment carries no coinsurance to 50% coinsurance, diabetic supplies range from no coinsurance to 20% coinsurance, and prosthetics, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Complete Blue PPO Signature (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic tests range from no copay to a $10 copay, outpatient X-rays have a $25 copay, and therapeutic and diagnostic radiological services require copays starting at $60 and $350, respectively.
Home Health Services See details
Home Health Services are covered under the Complete Blue PPO Signature (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Complete Blue PPO Signature (PPO) provides coverage for some Cardiac Rehabilitation Services with no copay and no coinsurance, although 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 no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services under the Complete Blue PPO Signature (PPO) plan are partially covered, featuring 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 additional services are not covered under this plan.
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