Complete Blue PPO Signature (PPO) Medicare Advantage Plan H5106-030-3 • 2027 • Wood County, WV
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $7150.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Wood County, WV
- Local Enrollment
- 294 beneficiaries in Wood County
Complete Blue PPO Signature (PPO) Introduction
This Medicare Advantage PPO plan, Complete Blue PPO Signature, is offered by Highmark Blue Cross Blue Shield and uses a Preferred Provider Organization (PPO) provider network. It comes with prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $7150.00. The plan is identified by CMS Plan ID H5106-030-3. The 2027 Part D prescription drug deductible is $700.00.
Enrollment in this plan requires residence in Wood County, West Virginia. CMS enrollment data reports 294 plan members in Wood County. New members can call the plan directly at (866)739-1899 (TTY 711) for assistance.
Compare Similar Plans in Wood County
Compare this plan with the two most-enrolled PPO plans available in Wood County, West Virginia. Enrollment is based on CMS local enrollment data.
| Plan Detail | Complete Blue PPO Signature | Humana Essentials Plus Giveback | Complete Blue PPO Distinct |
|---|---|---|---|
| CMS Plan ID | H5106-030-3 |
H7617-065-0 |
H5106-029-3 |
| Local Enrollment | 294 | 533 | 371 |
| Monthly Premium | $0.00 | $0.00 | $60.00 |
| Medical Deductible | $0.00 | $650 | $0.00 |
| Maximum Out-of-Pocket | $7,150.00 | $9,850.00 | $6,750.00 |
| Part B Giveback | Not offered | −$115.00 reduction | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $50 copay | $50 copay | $40 copay |
| Part D Deductible | $700.00 | $700.00 | $700.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $25 copay | $0 copay | $25 copay |
Plan Benefits
Cost-sharing for Complete Blue PPO Signature includes out-of-pocket expenses for covered healthcare services. The following tables provide a summary of typical in-network out-of-pocket costs for plan H5106-030-3.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5106-030-3 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: 40% coinsurance - Specialist
- In-network: $50 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-$50 copay
- Routine chiropractic
- In-network: $15 copay
Out-of-network: 40% coinsurance - Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - 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: $0-$30 copay
Out-of-network: 40% coinsurance - Outpatient x-rays
- In-network: $25 copay
Out-of-network: 40% coinsurance - Diagnostic tests and procedures
- In-network: $0-$10 copay
Out-of-network: 40% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $40 copay
- Inpatient hospital care
- In-network:
Tier 1
$435 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
$470 per day for days 1-7
$0 per day for days 8-90
$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: $310 copay
Out-of-network: $310 copay, 30% coinsurance
Mental Health Services
- Outpatient individual therapy
- In-network: $40 copay
Out-of-network: 40% coinsurance - Outpatient group therapy
- In-network: $40 copay
Out-of-network: 40% coinsurance - Inpatient psychiatric hospital care
- In-network:
Tier 1
$435 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
$470 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $50 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
- In-network: $0 copay
Out-of-network: 30% coinsurance - Dental x-rays
- In-network: $0 copay
Out-of-network: 30% coinsurance - Cleaning
- In-network: $0 copay
Out-of-network: 30% coinsurance - Periodontics
- In-network: 50% coinsurance
Out-of-network: 50% coinsurance - Endodontics
- In-network: 50% coinsurance
Out-of-network: 50% coinsurance - Restorative services
- In-network: 50% coinsurance
Out-of-network: 50% coinsurance - Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
Out-of-network: $50 copay - Contact lenses
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Eyeglass frames only
- In-network: $0-$40 copay
Out-of-network: $0 copay, 0% coinsurance - Eyeglass lenses only
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Eyeglasses (frames & lenses)
- In-network: $0-$40 copay
Out-of-network: $0 copay, 0% coinsurance - Upgrades
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Hearing Services
- Hearing exam
- In-network: $25 copay
Out-of-network: $25 copay - Fitting/evaluation
- Not covered
- Prescription hearing aids
- In-network: $699-$999 copay
Out-of-network: $0 copay, 0% coinsurance - 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 Signature as a Part B benefit.
Prescription Drug Coverage
Complete Blue PPO Signature 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 an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
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: | $0.00 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $12.80 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
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 Signature may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 21% coinsurance | Coming soon |
| Non-Preferred Drug | 25% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H5106)
Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.
| 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
- (866)739-1899
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (866)739-1899
- 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 Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Highmark Blue Cross Blue Shield (official source) | http://medicare.highmark.com | October 4, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| Medicare.gov | Joining a plan | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
MedicarePlans.com is an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Provenance documentation for this data is maintained under the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.