Complete Blue PPO Distinct (PPO)

by Highmark Blue Cross Blue Shield

2026 Medicare Advantage plan available in Delaware

Plan ID H8166-007-0

Additional coverage:

RxVision

Medicare Advantage PPO 4.0 Overall

Monthly plan premium $134 / mo

Annual deductible $0 / yr

Max out-of-pocket · in-network $6,500 / yr

Drug deductible $615 / yr

4.0 Overall Government Star Rating 2026 · out of 5 stars

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Plan Overview

Complete Blue PPO Distinct (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Delaware and offered by the health insurance company Highmark Blue Cross Blue Shield. This plan's network type is PPO, which determines the in-network doctors who accept the plan and whether a referral is needed.

Plan Name Complete Blue PPO Distinct (PPO)

Insurance Carrier Highmark Blue Cross Blue Shield

Plan Type Medicare Advantage Plan With Part D Prescription Drug Coverage

Network Type PPO

Cost Summary

Complete Blue PPO Distinct (PPO) has a monthly premium cost of $134 per month, with an annual deductible of $0 and a maximum out-of-pocket cost sharing of $6,500. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.

Monthly Premium $134 / mo

Health portion of premium $86

Drug portion of premium $48

Annual Deductible $0 / yr

Max Out-of-Pocket · in-network $6,500 / yr

Primary doctor visit $0 copay

Specialist visit $55 copay

ER visit $130 copay

Ambulance $320 copay

Additional Benefits and Coverage

Complete Blue PPO Distinct (PPO) is a Medicare Advantage plan which includes Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Complete Blue PPO Distinct (PPO) includes coverage for vision.

Part D Prescription Drug Coverage Yes

Dental No

Vision Yes

Hearing No

Nationwide Coverage No

Other benefits

Fitness benefit Limited coverage

Over-the-counter drug benefits Not covered

In-home support services Not covered

Home & bathroom safety devices Limited coverage

Meals for short duration Limited coverage

Annual physical exams Limited coverage

Telehealth Limited coverage

Medical Benefits

Doctor Services

Primary doctor visit In-network: $0 copay
Out-of-network: 40% coinsurance

Specialist visit In-network: $55 copay
Out-of-network: 40% coinsurance

Tests, labs & imaging

Diagnostic tests & procedures In-network: $10-$20 copay
Out-of-network: 40% coinsurance

Lab services In-network: $10-$20 copay
Out-of-network: 40% coinsurance

Diagnostic radiology services (like MRI) In-network: $300 copay
Out-of-network: 40% coinsurance

Outpatient x-rays In-network: $10 copay
Out-of-network: 40% coinsurance

Emergency care $130 copay

Urgent care $50 copay

Hospital Services

Inpatient hospital coverage In-network:
  Tier 1
  $355 per day for days 1-5
  $0 per day for days 6-90
  $0 per stay
Out-of-network:
  $425 per day for days 1-5
  $0 per day for days 6-90
  $0 per stay

Outpatient hospital coverage In-network: $350 copay
Out-of-network: $425 copay

Skilled nursing facility

Skilled nursing facility In-network:
  Tier 1
  $0 per day for days 1-20
  $218 per day for days 21-100
Out-of-network:
  30% per stay

Preventive services

Preventive services In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance In-network: $320 copay
Out-of-network: $320 copay

Therapy services

Occupational therapy visit In-network: $35 copay
Out-of-network: 40% coinsurance

Physical therapy & speech & language therapy visit In-network: $35 copay
Out-of-network: 40% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist In-network: $30 copay
Out-of-network: 40% coinsurance

Outpatient individual therapy with a psychiatrist In-network: $30 copay
Out-of-network: 40% coinsurance

Outpatient group therapy visit In-network: $30 copay
Out-of-network: 40% coinsurance

Outpatient individual therapy visit In-network: $30 copay
Out-of-network: 40% coinsurance

Opioid treatment services

Opioid treatment services Covered

Other services

Durable medical equipment (like wheelchairs & oxygen) In-network: 0%-50% coinsurance
Out-of-network: 40%-50% coinsurance

Prosthetics (like braces, artificial limbs) In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Diabetes supplies In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance

Prescription drugs (Part D benefits)

Drug tier standard retail · 1-month supply Initial coverage Catastrophic

Generic Drugs 25% coinsurance 0% coinsurance

Brand Name Drugs 25% coinsurance 0% coinsurance

Part B drugs

Chemotherapy drugs In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance

Other Part B drugs In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance

Medicare star rating

Each year the federal government rates Medicare Advantage and Part D plans on a 5-star system covering quality of care, chronic-condition management, member experience, and customer service. For 2026, Complete Blue PPO Distinct (PPO) earned an overall rating of 4.0 stars — better than Delaware's state average of 3.8 stars.

Rating category This plan State average

Overall star rating ★ 4.0 3.8

Health plan quality

Summary rating of health plan quality ★ 3.5 3.7

Staying healthy: screenings, tests & vaccines ★ 4.0 3.6

Managing chronic (long-term) conditions ★ 4.0 3.5

Member experience with health plan ★ 3.0 3.6

Member complaints & changes in performance ★ 4.0 3.8

Health plan customer service ★ 4.0 4.3

Drug plan quality

Summary rating of drug plan quality ★ 4.0 3.6

Drug plan customer service ★ 4.0 4.8

Member complaints & changes in performance ★ 4.0 3.5

Member experience with the drug plan ★ 3.0 3.4

Drug safety & accuracy of drug pricing ★ 4.0 3.7

Extra Benefits

Hearing

Hearing exam Not covered

Fitting/evaluation Not covered

Hearing aids - prescription Not covered

Hearing aids - over the counter Not covered

Preventive dental

Oral exam Not covered

Cleaning Not covered

Fluoride treatment Not covered

Dental x-rays Not covered

Comprehensive dental

Restorative services Not covered

Endodontics Not covered

Periodontics Not covered

Prosthodontics, removable Not covered

Prosthodontics, fixed Not covered

Maxillofacial prosthetics Not covered

Implant services Not covered

Oral and maxillofacial surgery Not covered

Orthodontics Not covered

Adjunctive general services Not covered

Vision

Routine eye exam In-network: $0 copay
Out-of-network: $50 copay

Contact lenses Not covered

Eyeglasses (frames & lenses) Not covered

Eyeglass frames (only) Not covered

Eyeglass lenses (only) Not covered

Upgrades In-network: $0 copay
Out-of-network: $0 copay

Plan documents & tools

Plan details (carrier site)Provider directory Drug list (formulary)

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