Plan year 2026 · coverage ends Dec. 31, 2026CMS crosswalk of Oct. 1, 2026
Complete Blue PPO Distinct is not offered under this ID in 2027
H5106Contract036Plan
PPO · served 15 counties in West Virginia in 2026
Run by Highmark Senior Solutions Company (contract H5106), sold as Highmark Blue Cross Blue Shield, owned by Highmark Health
CMS crosswalk: members move into H5106-029 in 4 of its 15 counties; in the others the plan ends
Complete Blue PPO Distinct (H5106-036) is not offered under this ID in 2027. The CMS plan crosswalk of October 1, 2026 moves its members into Complete Blue PPO Distinct (H5106-029), in the 4 counties where that plan is sold (132 members in September 2026). In its other 11 counties (169 members) there is no plan to move into: coverage ends December 31, 2026, and members there need to choose a new plan (counties with fewer than 11 members are not counted).
What changes for its members in Complete Blue PPO Distinct?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| Monthly premium | $54 | $53 to $60 | ▼down $1 |
| 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) | $40 copay | $35 copay | ▼down $5 |
| Hospital stay, in network (best in its area) | $250 a day for days 1–5, then $0 a day for days 6–90 | $265 a day for days 1–5, then $0 a day for days 6–90 | ▲up $75for 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) | $535 copay | $315 copay | ▼down $220 |
| Eyewear, yearly limit (best in its area) | $350 a year | not offered | ▼dropped |
| Counties served | 15 | 30 | ▲up 15 |
| Drug tier 3, preferred brand | 20% of the cost | 21% of the cost | ▲up 1 point |
| 11 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 |
| Over-the-counter items, yearly (best in its area) | $200 a year | $200 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 plan crosswalk from 2026 to 2027 (Oct. 1, 2026); 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. Your plan's Annual Notice of Change is the letter that confirms your 2027 plan; confirm on Medicare Plan Finder.
What can members do, and by when?
If you live in Monongalia (WV), Preston (WV), Ritchie (WV), Wirt (WV)
- If you do nothing
- You are moved into Complete Blue PPO Distinct on January 1, 2027.
- October 15 to December 7, 2026
- Open enrollment: choose another Medicare Advantage plan, or Original Medicare with a drug plan, instead.
If you live in Calhoun (WV), Hampshire (WV), Hancock (WV), Monroe (WV), Morgan (WV), Pendleton (WV), Summers (WV), Taylor (WV), Tucker (WV), Tyler (WV), Webster (WV)
- Your coverage
- Ends December 31, 2026: Complete Blue PPO Distinct is not sold where you live.
- October 15 to December 7, 2026
- Open enrollment: join another Medicare Advantage plan, or Original Medicare with a drug plan. Coverage starts January 1, 2027.
- December 8, 2026 to the end of February 2027
- A special enrollment period because the plan is leaving: you can still join a plan, but coverage starts the first day of the month after you join, so choose by December 31 to have no gap.
- If you do nothing
- You are enrolled in Original Medicare when the plan ends, without a drug plan unless you join one (with Extra Help or full Medicaid, Medicare enrolls you in one).
- Without a drug plan
- Going 63 days or more in a row without drug coverage can mean a late enrollment penalty if you join a drug plan later; joining by the end of February keeps a January and February gap under 63 days, waiting longer does not.
Source: Medicare.gov, “Special enrollment periods” and “Joining a plan” (read Oct. 7, 2026).
Where did its members live?
Where its members lived in September 2026; each county and state page lists the 2027 plans sold there.
| County | Members, Sept. 2026 | For 2027 |
|---|---|---|
| Monongalia, WV | 95 | moves into H5106-029 |
| Monroe, WV | 61 | plan ends here |
| Preston, WV | 37 | moves into H5106-029 |
| Summers, WV | 33 | plan ends here |
| Morgan, WV | 24 | plan ends here |
| Hancock, WV | 23 | plan ends here |
| Hampshire, WV | 16 | plan ends here |
| Taylor, WV | 12 | plan ends here |
| Calhoun, WV | fewer than 11 | plan ends here |
| Pendleton, WV | fewer than 11 | plan ends here |
| Ritchie, WV | fewer than 11 | moves into H5106-029 |
| Tucker, WV | fewer than 11 | plan ends here |
| Tyler, WV | fewer than 11 | plan ends here |
| Webster, WV | fewer than 11 | plan ends here |
| Wirt, WV | fewer than 11 | moves into H5106-029 |
Source: CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11).
What else should you check?
- 2027 plans in Monongalia, WVThe plans you can join instead
- Highmark Blue Cross Blue Shield plans for 2027Plans the same company still offers
- Every plan not offered in 2027764 Medicare Advantage and drug plans