Complete Blue PPO Premier (PPO) H3916-044-1 Plan Details
Complete Blue PPO Premier (PPO) H3916-044-1 Plan Details
When selecting a Medicare Advantage plan for 2025, it's important to compare all your options. Complete Blue PPO Premier (PPO) is among the plans you can review side-by-side with others, ensuring you find the coverage that suits your needs. You can easily enroll online or reach out to a licensed agent for personalized guidance.
Complete Blue PPO Premier Overview
Plan ID H3916-044-1 Overview | |
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Health Plan ID: | H3916-044-1 |
Medicare Advantage Plan Type: | Local PPO |
Plan Year: | 2024 |
Monthly Premium: | $46.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | $4,900 |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
Part D Gap Coverage: | No |
Supplemental Benefits: | Vision, Hearing |
Availability: | See List |
Insured By: | Highmark Blue Cross Blue Shield or Highmark Blue Shield |
Explore Complete Blue PPO Premier Benefits
Complete Blue PPO Premier is a Medicare Advantage Prescription Drug (MAPD) Preferred Provider Organization (PPO) plan that offers both flexibility and comprehensive coverage. With a monthly premium of $46.00, this plan includes all the essential benefits of Medicare Part A and Part B, plus additional services like prescription drug coverage. There is no annual deductible. Cost sharing begins with your first prescription. As a PPO plan, you can visit providers both in and out of the network, although staying in-network usually means lower costs.
Complete Blue PPO Premier also provides financial protection with an annual maximum out-of-pocket (MOOP) limit of $4,900. After reaching this limit, the plan covers 100% of your in-network healthcare costs for the remainder of the year. This feature makes Complete Blue PPO Premier an excellent option for those who value both comprehensive coverage and the ability to choose their providers.
We're Here to Help You Enroll |
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Cost-Sharing Overview
Complete Blue PPO Premier includes cost-sharing, which refers to the out-of-pocket expenses you'll incur when accessing approved healthcare services. The table below outlines the most common in-network out-of-pocket costs for plan H3916-044-1.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 |
Specialist: | $0 |
Wellness & Preventive Programs: | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $0 |
Routine Foot Care: | $0 |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $20 Copay Prior Authorization Required |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | $100 Copay |
Urgent care: | $15 Copay |
Ground ambulance: | $275 Copay |
Inpatient hospital care: | $225.00 per stay |
Outpatient hospital care: | $175 Copay Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $203.00 per day for days 21 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $30 Copay |
Outpatient group therapy: | $30 Copay |
Inpatient psychiatric hospital care: | $300.00 per stay |
Outpatient group therapy: | $30 Copay |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $0 |
Occupational therapy: | $0 |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $150 Copay Prior Authorization Required |
Lab services: | $0 |
Outpatient x-rays: | $10 Copay Prior Authorization Required |
Diagnostic tests and procedures: | $0 |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Most preventive services are covered 100% by Complete Blue PPO Premier as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that Highmark Blue Cross Blue Shield or Highmark Blue Shield offers with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | Not Covered |
Vision | Maximum vision benefit: | Non Specified |
Eyeglasses (frames and lenses) (In-Network) | Not Covered |
Routine eye exam (In-Network) | Covered Limits may apply |
Contact lenses (In-Network) | Covered Limits may apply |
Additional Benefits
None specified.
Part D Prescription Drug Costs & Benefits
Complete Blue PPO Premier includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
While the prescription drug plan (Part D) premium is included in the overall plan cost, some plans may have additional costs or provide assistance through the Low-Income Subsidy (LIS) program. Also known as Extra Help, LIS is a Social Security program that assists individuals with limited income and resources in reducing or eliminating Part D expenses.
The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $38.60 |
Supplemental Part D Premium: | $7.40 |
Total Part D Premium: | $46.00 |
Part D Premium with Full LIS Assistance: | $7.40 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. You must pay this amount at the pharmacy before Highmark Blue Cross Blue Shield or Highmark Blue Shield begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Complete Blue PPO Premier has out-of-pocket costs that you must pay when you pick up your prescriptions.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | $0.00 copay | $7.00 copay |
2 (Generic) | $0.00 copay | $20.00 copay |
3 (Preferred Brand) | $42.00 copay | $47.00 copay |
4 (Non-Preferred Drug) | $100.00 copay | $100.00 copay |
5 (Specialty Tier) | 33% | 33% |
CMS 5-Star Rating Overview
The Centers for Medicare & Medicaid Services (CMS) reviews and rates Medicare Advantage (Part C) and drug plans (Part D) annually, using a 5-star system to measure aspects such as member satisfaction, preventive services, and management of chronic conditions.
Higher star ratings generally indicate better plan performance, which can be a useful factor to consider when deciding on a plan that aligns with your healthcare goals and preferences.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
Plan Availability
Complete Blue PPO Premier (H3916-044-1) is available in the following locations (click to open):
Am I Eligible for Complete Blue PPO Premier?
To qualify for enrollment in Complete Blue PPO Premier, you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
- Not have End-Stage Renal Disease (ESRD), except under certain conditions.
If you fulfill these criteria, you can enroll in Complete Blue PPO Premier and enjoy the extensive healthcare benefits it offers.
Enrollment Periods for Complete Blue PPO Premier
Knowing when you can enroll in Complete Blue PPO Premier is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) for expert guidance from a licensed insurance agent.
How to Enroll in Complete Blue PPO Premier
Getting started with Complete Blue PPO Premier is simple. Here are your options:
- Online Enrollment: Easily enroll online using a secure form. Visit the MedicareEnrollment.com enrollment page and follow the steps to complete your enrollment.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711). A licensed insurance agent will guide you through the process and answer any questions.
- Through Medicare.gov: Enroll through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the instructions to join a Medicare Advantage plan.
- Directly with the Plan: You can also enroll directly with Complete Blue PPO Premier. The plan's contact information is available below in the "Contact" section.
Be sure to enroll during the appropriate period to ensure your coverage begins without delay.
Contact Highmark Blue Cross Blue Shield or Highmark Blue Shield
Website: | http://medicare.highmark.com |
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Formulary: | http://medicare.highmark.com |
Pharmacy: | Highmark Blue Cross Blue Shield or Highmark Blue Shield Pharmacy Page |
New Members: | (866)743-5478 |
TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, you can do so on the Social Security Administration website. For more information about the Medicare Part C program, visit the official Medicare website or call 1-800-MEDICARE.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
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