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Complete Blue PPO Distinct (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Complete Blue PPO Distinct (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 Distinct (PPO) in 2026, please refer to our full plan details page.
Complete Blue PPO Distinct (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 Distinct (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 Distinct (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 Distinct (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $134.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $16.00. 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 $8950.00 (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 $8950.00 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 Distinct (PPO) prescription drug plan has an annual drug deductible of $615. You must pay this deductible amount out-of-pocket for your covered medications before the plan begins to cover its share of your prescription costs. Detailed information regarding specific drug tiers, copays, and coinsurance is currently unavailable for this plan. To determine your exact out-of-pocket costs, you should consult the plan's formulary to see how your specific medications are categorized.
Additional Benefits
The Complete Blue PPO Distinct (PPO) plan offers comprehensive medical coverage with no copay for primary care visits and a fifty-five dollar copay for specialist visits. Inpatient hospital stays require daily copays for the first few days and no copay thereafter, while outpatient hospital services carry a three hundred fifty dollar copay. Emergency care is covered with a one hundred thirty dollar copay, which is waived if you are admitted, and urgently needed services require a fifty dollar copay. Preventive services, home health care, and partial hospitalization are fully covered with no copays or coinsurance. Diagnostic services like lab tests and X-rays feature low copays starting at ten dollars, while durable medical equipment and dialysis generally require coinsurance up to fifty percent. While the plan partially covers Medicare-covered dental, vision, and hearing exams with a fifty-five dollar copay, it does not cover routine dental care, hearing aids, or standard corrective eyewear.
Inpatient Hospital See details
Complete Blue PPO Distinct (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $355 daily copay for days 1 to 5 and no copay for additional days, while psychiatric stays require a $425 daily copay for days 1 to 3 and no copay for days 4 to 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Complete Blue PPO Distinct (PPO) covers outpatient services with no coinsurance, featuring a $350 copay for outpatient hospital and observation services and a $300 copay for ambulatory surgical center services. Outpatient substance abuse services carry a $30 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Complete Blue PPO Distinct (PPO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Complete Blue PPO Distinct (PPO), with ground and air ambulance services requiring a $320.00 copay and no coinsurance, subject to prior authorization. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Complete Blue PPO Distinct (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within three days. Urgently needed services have a $50 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $130 for emergency care, $50 for urgent care, and $320 for emergency transportation.
Primary Care See details
Complete Blue PPO Distinct (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $55 copay and no coinsurance. Physical and occupational therapy services have a $35 copay and no coinsurance, while chiropractic care is partially covered with routine care costing no copay and no coinsurance but excluding other chiropractic services.
Preventive Services See details
Complete Blue PPO Distinct (PPO) covers annual physical exams, kidney disease education, and other preventive screenings with no copay and no coinsurance. Additional preventive services are partially covered, offering remote access technologies with a $0 to $55 copay and no coinsurance, and home safety devices with a 20% coinsurance and no copay, while sub-services such as health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by Complete Blue PPO Distinct (PPO), which features hearing exams with a $55 copay and no coinsurance, though routine hearing exams and fitting/evaluations are not covered. Some prescription hearing aid services are covered, but OTC hearing aids and all prescription hearing aid types—including inner ear, outer ear, and over the ear—are not covered.
Vision Services See details
Complete Blue PPO Distinct (PPO) offers partially covered vision services, including one routine eye exam per year for a $55 copay and no coinsurance, while other eye exams are not covered. Some eyewear services are covered with no copay or coinsurance up to a $200 annual limit, but contact lenses, eyeglasses, lenses, and frames are not covered.
Dental Services See details
Complete Blue PPO Distinct (PPO) partially covers dental services, offering coverage only for Medicare-covered dental services with a $55.00 copay and no coinsurance. Routine and corrective services, including oral exams, cleanings, x-rays, fluoride, restorative treatment, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics, are not covered.
Home Infusion bundled Services See details
Complete Blue PPO Distinct (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Complete Blue PPO Distinct (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Complete Blue PPO Distinct (PPO) covers medical equipment with no copay, though prior authorization is required. Durable medical equipment features coinsurance ranging from no coinsurance up to 50%, while prosthetic devices, medical supplies, and diabetic therapeutic shoes have a 20% coinsurance. Diabetic supplies, which are limited to specified manufacturers, range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Complete Blue PPO Distinct (PPO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. Members will pay a $10 copay for lab services and outpatient X-rays, a $10 to $20 copay for diagnostic procedures, and minimum copays of $60 for therapeutic radiology and $300 for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the Complete Blue PPO Distinct (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Complete Blue PPO Distinct (PPO) provides Cardiac Rehabilitation Services where some services are covered with no copay and no coinsurance; however, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Complete Blue PPO Distinct (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no preceding 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 Medicare-covered limit are not covered.
Other Services See details
Other Services under the Complete Blue PPO Distinct (PPO) plan are partially covered, offering a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered.
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