Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026

Complete Blue PPO Distinct, 2027

H5106Contract029Plan

PPO · 30 counties in West Virginia

Run by Highmark Senior Solutions Company (contract H5106), sold as Highmark Blue Cross Blue Shield, owned by Highmark Health

Takes in 1 plan

2026 star rating, contract H5106: 3.5 of 5

Complete Blue PPO Distinct (H5106-029) costs $53 to $60 a month in 2027, up $29 from 2026, with an in-network out-of-pocket limit of $6,500 to $6,750 depending on the county ($6,750 in 2026). It takes in the members of H5106-036.

What changes from 2026 to 2027?

The changed lines are marked and come first. In-network amounts; members keep paying the Part B premium unless the plan reduces it. Where the plan files different amounts for parts of its area, the premium and limit show their range (your county's are in the table below). The plan files its benefits in parts for different counties, so lines marked ◆ show the most generous part of its area and some counties get less: the plan's Evidence of Coverage gives your county's amounts.
What you pay or get	2026	2027	Change
Monthly premium	$24 to $25	$53 to $60	up $29
In-network out-of-pocket limit, by county	$6,750	$6,500 to $6,750	no change
Drug deductible	$615	$700	up $85
Specialist visit (best in its area)	$25 copay	$35 copay	up $10
Hospital stay, in network (best in its area)	$195 a day for days 1–3, then $0 a day for days 4–90	$265 a day for days 1–5, then $0 a day for days 6–90	up $740for a 5-day stay
Skilled nursing facility, in network (best in its area)	$0 a day for days 1–20, then $218 a day for days 21–100	$0 a day for days 1–20, then $221 a day for days 21–100	up $30for a 30-day stay
Ground ambulance, in network (best in its area)	$270 copay	$315 copay	up $45
Eyewear, yearly limit (best in its area)	$350 a year	not offered	dropped
Over-the-counter items, yearly (best in its area)	$160 a year	$200 a year	up $40
Counties served	26	30	up 4
Drug tier 3, preferred brand	20% of the cost	21% of the cost	up 1 point
10 lines do not change
Part B premium reduction, monthly (best in its area)	none	none	no change
Primary care visit (best in its area)	$0 copay	$0 copay	no change
Emergency room (best in its area)	$130 copay	$130 copay	no change
Medical deductible, in network (best in its area)	none	none	no change
Comprehensive dental, yearly limit (best in its area)	not offered	not offered	no change
Hearing aids, yearly limit for both ears (best in its area)	$500 a year	$500 a year	no change
Drug tier 1, preferred generic	$7	$7	no change
Drug tier 2, generic	$15	$15	no change
Drug tier 4, non-preferred drug	25% of the cost	25% of the cost	no change
Drug tier 5, specialty tier	25% of the cost	25% of the cost	no change

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?

Your share for a 30-day supply at a retail pharmacy, as filed with CMS; tiers whose share changes are marked. The plan charges less at its preferred pharmacies
Tier	What the tier holds	2026, standard pharmacy	2027, standard pharmacy	2027, preferred pharmacy
Tier 1	Preferred Generic	$7	$7	$0
Tier 2	Generic	$15	$15	$0
Tier 3	Preferred Brand	20% of the cost	21% of the cost	21% of the cost
Tier 4	Non-Preferred Drug	25% of the cost	25% of the cost	25% of the cost
Tier 5	Specialty Tier	25% of the cost	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, 42 plans open to everyone are sold for 2027, this one included. Against the others, 2 plans have a lower out-of-pocket limit, 2 the same, 37 a higher one. On the premium, 34 plans have a lower premium, 7 a higher one.

Its limit differs by county ($6,500 to $6,750); the chart marks its lowest.

Out-of-pocket limits of the 42 plans open to everyone

$0 to under $2,0000 plans

$2,000 to under $4,0000 plans

$4,000 to under $6,0001 plan

$6,000 to under $8,000 (this plan)23 plans

$8,000 to $10,00018 plans

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?

30 counties, grouped by what the plan costs there
Monthly premium	Out-of-pocket limit	Where
$53	$6,500	Kanawha (WV), Lincoln (WV), Putnam (WV)
$55	$6,500	Berkeley (WV), Cabell (WV), Clay (WV), Fayette (WV), Marshall (WV), Ohio (WV), Wayne (WV)
$60	$6,750	Braxton (WV), Brooke (WV), Doddridge (WV), Greenbrier (WV), Hardy (WV), Harrison (WV), Jefferson (WV), Marion (WV), Mason (WV), McDowell (WV), Mercer (WV), Mingo (WV), Monongalia (WV), Nicholas (WV), Preston (WV), Raleigh (WV), Randolph (WV), Ritchie (WV), Wirt (WV), Wood (WV)

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, beside its own 7,197 members. In 2027 it costs $53 to $60 a month with a $6,500 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 DistinctH5106-036	339	132	$54	down $1	$6,750	down $250

Only the members of Complete Blue PPO Distinct (H5106-036) who live in the 4 counties where this plan is sold move into it (132 of its 339 members); in its other 11 counties the plan ends and members choose a new one. What happens where.

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: H5106-029
Legal name of the contract: Highmark Senior Solutions Company
Sold as: Highmark Blue Cross Blue Shield
Parent company: Highmark Health
Plan type: PPO
2026 star rating of the contract: 3.5 of 5 overall; health plan 3.5 of 5, drug plan 3.5 of 5
Members, September 2026: 7,197
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 Kanawha, WVWhere most of its members live; premiums and limits side by side
Every Highmark Blue Cross Blue Shield plan for 2027Its contracts, counties and plans that end
The other 3 plans of contract H5106Same 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.