Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026
Complete Blue PPO Merit, 2027
H3916Contract069Plan
PPO · 25 counties in Pennsylvania
Run by Highmark Senior Health Company (contract H3916), sold as Highmark Blue Cross Blue Shield or Highmark Blue Shield, owned by Highmark Health
Complete Blue PPO Merit (H3916-069) costs $0 a month in 2027, with an in-network out-of-pocket limit of $8,300. It is a new plan for 2027. It takes in the members of H3916-066.
What changes from 2026 to 2027?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| Monthly premium | not offered | $0 | new for 2027 |
| In-network out-of-pocket limit | not filed | $8,300 | new for 2027 |
| Drug deductible | not filed | $700 | new for 2027 |
| Part B premium reduction, monthly (best in its area) | none | $77 | ▲added |
| Primary care visit (best in its area) | not offered | $0 copay | changed |
| Specialist visit (best in its area) | not offered | $40 copay | changed |
| Emergency room (best in its area) | not offered | $115 copay | changed |
| Medical deductible, in network (best in its area) | none | $200 | ▲added |
| Hospital stay, in network (best in its area) | not offered | $400 a day for days 1–5, then $0 a day for days 6–90 | changed |
| Skilled nursing facility, in network (best in its area) | not offered | $0 a day for days 1–20, then $221 a day for days 21–100 | changed |
| Ground ambulance, in network (best in its area) | not offered | $320 copay | changed |
| Hearing aids, yearly limit for both ears (best in its area) | not offered | $500 a year | ▲added |
| 4 lines do not change | |||
| Comprehensive dental, yearly limit (best in its area) | not offered | not offered | no change |
| Eyewear, yearly limit (best in its area) | not offered | not offered | no change |
| Over-the-counter items, yearly (best in its area) | not offered | not offered | no change |
| Counties served | not offered | 25 | new for 2027 |
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.
What will prescriptions cost?
| Tier | What the tier holds | 2026, standard pharmacy | 2027, standard pharmacy | 2027, preferred pharmacy |
|---|---|---|---|---|
| Tier 1 | Preferred Generic | not offered | $7 | $0 |
| Tier 2 | Generic | not offered | $15 | $0 |
| Tier 3 | Preferred Brand | not offered | 23% of the cost | 23% of the cost |
| Tier 4 | Non-Preferred Drug | not offered | 25% of the cost | 25% of the cost |
| Tier 5 | Specialty Tier | not offered | 25% of the cost | 25% of the cost |
Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.
How does it compare with plans sold where it is?
In the counties it serves, 94 plans open to everyone are sold for 2027, this one included. Against the others, 73 plans have a lower out-of-pocket limit, 2 the same, 18 a higher one. On the premium, 55 the same, 38 a higher one.
Out-of-pocket limits of the 94 plans open to everyone
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Where is it sold, and what does it cost there?
The premium and the out-of-pocket limit are the same in all 25 counties: $0 a month and $8,300.
Pennsylvania
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Which 2026 plans move into it, and what changes for their members?
For 2027 this plan takes in the members of 1 other plan. In 2027 it costs $0 a month with a $8,300 limit; each row compares that with the plan its members had in 2026.
| 2026 plan | Members, Sept. 2026 | Members who move | Premium 2026 | Premium change | Limit 2026 | Limit change |
|---|---|---|---|---|---|---|
| Complete Blue PPO MeritH3916-066 | 5,692 | 5,644 | $0 | no change | $8,300 | no change |
Source: CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11); CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision). Each moving plan's own page lists every line that changes for its members.
Who runs this plan?
- Plan ID
- H3916-069
- Legal name of the contract
- Highmark Senior Health Company
- Sold as
- Highmark Blue Cross Blue Shield or Highmark Blue Shield
- Parent company
- Highmark Health
- Plan type
- PPO
- 2026 star rating of the contract
- 4.5 of 5 overall; health plan 4 of 5, drug plan 4.5 of 5
- Plan website, as filed with CMS
- medicare.highmark.com
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.
What else should you check?
- Other 2027 plans in Lancaster, PAWhere most of its members live; premiums and limits side by side
- Every Highmark Blue Cross Blue Shield or Highmark Blue Shield plan for 2027Its contracts, counties and plans that end
- The other 25 plans of contract H3916Same company, same contract
- Is your prescription covered?Coverage share and tier for 2,259 drugs
Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.