Complete Blue PPO Distinct (PPO) Medicare Advantage Plan H8166-007 • 2027 • Kent County, DE
- Monthly Premium
- $167.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $7150.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Basic, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Kent County, DE
- Local Enrollment
- 84 beneficiaries in Kent County
Complete Blue PPO Distinct (PPO) Introduction
CMS Plan ID H8166-007 identifies Complete Blue PPO Distinct, a Medicare Advantage PPO plan offered by Highmark Blue Cross Blue Shield. The plan uses a Preferred Provider Organization (PPO) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $167.00 monthly premium, $0.00 medical deductible, and $7150.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $700.00.
This plan is available to eligible beneficiaries who live in Kent County, Delaware. CMS reports local enrollment of 84 beneficiaries for this plan in Kent County. New members can contact the plan at (833)611-7926 (TTY 711) for help and additional plan information.
Compare Similar Plans in Kent County
Compare this plan with the two most-enrolled PPO plans available in Kent County, Delaware. Enrollment is based on CMS local enrollment data.
| Plan Detail | Complete Blue PPO Distinct | AARP Medicare Advantage from UHC DE-0001 | AARP Medicare Advantage from UHC DE-0002 |
|---|---|---|---|
| CMS Plan ID | H8166-007-0 |
H2406-075-0 |
H2406-100-0 |
| Local Enrollment | 84 | 1,192 | 1,095 |
| Monthly Premium | $167.00 | $23.00 | $68.00 |
| Medical Deductible | $0.00 | $1,000 | $1,000 |
| Maximum Out-of-Pocket | $7,150.00 | $7,150.00 | $7,150.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $55 copay | $0-$60 copay | $0-$50 copay |
| Part D Deductible | $700.00 | $685.00 | $685.00 |
| CMS Star Rating | 3.0 | 4.0 | 4.0 |
| Dental | Not covered | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | Not covered | $0 copay | $0 copay |
Want to explore more options? Browse all Medicare Advantage plans in Kent County, or compare Medicare Advantage plans across Delaware, including premiums, out-of-pocket costs, CMS ratings, and enrollment.
Plan Benefits
Complete Blue PPO Distinct has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H8166-007.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H8166-007-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: 40% coinsurance - Specialist
- In-network: $55 copay
Out-of-network: 40% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Telehealth benefit
- In-network: $0-$55 copay
- Routine chiropractic
- In-network: $0 copay
Out-of-network: 40% coinsurance - Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- Not covered
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $350 copay
Out-of-network: 40% coinsurance - Lab services
- In-network: $10-$25 copay
Out-of-network: 40% coinsurance - Outpatient x-rays
- In-network: $10 copay
Out-of-network: 40% coinsurance - Diagnostic tests and procedures
- In-network: $10-$20 copay
Out-of-network: 40% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $50 copay
- Inpatient hospital care
- In-network:
Tier 1
$375 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
$450 per day for days 1-10
$0 per day for days 11-90
$0 per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100
Out-of-network:
30% per stay - Ground ambulance
- In-network: $275 copay
Out-of-network: $275 copay, 30% coinsurance
Mental Health Services
- Outpatient individual therapy
- In-network: $30 copay
Out-of-network: 40% coinsurance - Outpatient group therapy
- In-network: $30 copay
Out-of-network: 40% coinsurance - Inpatient psychiatric hospital care
- In-network:
Tier 1
$375 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
$450 per day for days 1-10
$0 per day for days 11-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $55 copay
Out-of-network: 40% coinsurance - Occupational therapy
- In-network: $50 copay
Out-of-network: 40% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance - Durable medical equipment
- In-network: 0%-50% coinsurance
Out-of-network: 40%-50% coinsurance - Prosthetics
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance
Dental Services
- Oral exam
- Not covered
- Dental x-rays
- Not covered
- Cleaning
- Not covered
- Periodontics
- Not covered
- Endodontics
- Not covered
- Restorative services
- Not covered
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- Not covered
Vision Services
- Routine eye exam
- In-network: $0 copay
Out-of-network: $50 copay - Contact lenses
- Not covered
- Eyeglass frames only
- Not covered
- Eyeglass lenses only
- Not covered
- Eyeglasses (frames & lenses)
- Not covered
- Upgrades
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Hearing Services
- Hearing exam
- Not covered
- Fitting/evaluation
- Not covered
- Prescription hearing aids
- Not covered
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance
Certain preventive services are covered 100% by Complete Blue PPO Distinct as a Part B benefit.
Prescription Drug Coverage
Complete Blue PPO Distinct includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes a basic benefit Medicare Part D plan (PDP), meeting the minimum coverage requirements defined by CMS.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $58.80 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $58.80 |
| Low-Income Premium Subsidy: | $7.88 |
| Low-Income Premium Subsidy Paid by CMS: | $7.90 |
| Low-Income Subsidy Premium: | $50.90 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Highmark Blue Cross Blue Shield starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Complete Blue PPO Distinct may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | Coming soon |
| Generic drugs | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H8166)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 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 |
Contact Information for Highmark Blue Cross Blue Shield
- Website
- Highmark Blue Cross Blue Shield Plan Page
- Providers
- Highmark Blue Cross Blue Shield Providers Page
- Formulary
- Highmark Blue Cross Blue Shield Formulary Page
- Pharmacy
- Highmark Blue Cross Blue Shield Pharmacy Page
- New Member Health Plan Help
- (833)611-7926
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (833)611-7926
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Advantage Plan Availability
Complete Blue PPO Distinct is available to eligible Medicare beneficiaries residing in Kent County, Delaware, including communities such as Dover, Camden Wyoming, Clayton, Felton, Frederica, Harrington, Hartly, Magnolia, Smyrna, and other areas throughout the county. Enrollment eligibility is based on county of residence, not city.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | November 10, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Highmark Blue Cross Blue Shield (official source) | http://medicare.highmark.com | October 4, 2026 |
| Medicare.gov | Compare types of Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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