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Freedom Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Freedom Plus (HMO) in 2025, please refer to our full plan details page.
Freedom Plus (HMO) is a HMO plan offered by Highmark Health available for enrollment in 2025 to people living in Northeastern New York. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Freedom Plus (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Freedom Plus (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Freedom Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $37.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6700.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Freedom Plus (HMO) plan has an "Enhanced Alternative" drug benefit. The plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance for your prescriptions. For example, you will pay an $8.00 copay at a preferred pharmacy for preferred generic drugs.
Additional Benefits
The Freedom Plus (HMO) plan provides coverage for a wide range of services, including inpatient hospital stays with varying copays, outpatient services with copays, and emergency services with copays. Additionally, it covers primary care, preventive services, hearing, vision, and dental services. This plan offers coverage for ambulance services with copays, home health services with no copay, and skilled nursing facility stays with a copay after the first 20 days. The plan also provides benefits for medical equipment, diagnostic and radiological services, and other services such as over-the-counter items.
Inpatient Hospital See details
The Freedom Plus (HMO) plan covers inpatient hospital stays, including acute and psychiatric care, with prior authorization required. For inpatient hospital-acute, you pay a copay of $325 for days 1-4, and no copay for days 5-90, with a service-specific out-of-pocket maximum of $1,300. For inpatient hospital-psychiatric, you pay a copay of $275 for days 1-6, and no copay for days 7-90, with a service-specific out-of-pocket maximum of $1,650. Additional days for inpatient hospital-acute are covered, while upgrades, and non-medicare-covered stays for inpatient hospital-acute are covered. Additional days and non-medicare-covered stays for inpatient hospital-psychiatric, and upgrades for inpatient hospital-acute are not covered.
Outpatient Services See details
Outpatient Services are covered by the Freedom Plus (HMO) plan, including all outpatient hospital services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services and observation services each have a copay of $330, while ambulatory surgical center services have a copay of $230. Individual and group sessions for outpatient substance abuse each have a copay between $40 and $40.
Partial Hospitalization See details
Freedom Plus (HMO) covers partial hospitalization with a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Freedom Plus (HMO) plan. Ground and air ambulance services have a $275 copay with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Freedom Plus (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The Freedom Plus (HMO) plan covers Primary Care Physician Services with a copay of $0-$10, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $35 copay, and Mental Health Specialty Services with a $40 copay for individual and group sessions. The plan also covers Podiatry Services with a $35 copay, Other Health Care Professional services with a copay of $0-$35, Psychiatric Services with a $40 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $25 copay, Additional Telehealth Benefits with a copay of $0-$55, and Opioid Treatment Program Services with a $40 copay.
Preventive Services See details
Preventive Services, including Medicare-covered services, Annual Physical Exams, and other preventive services, are covered by the Freedom Plus (HMO) plan. Additional services such as In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services with the Freedom Plus (HMO) plan include hearing exams with a $35 copay, and routine hearing exams with a copay of $45, once per year. Prescription hearing aids (all types) are covered with a copay between $499 and $799, twice per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Freedom Plus (HMO) plan covers vision services, including eye exams with a copay between $0 and $35, and eyewear with a combined maximum benefit of $200 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Freedom Plus (HMO) offers dental services including oral exams with a $35 copay, dental x-rays, and prophylaxis (cleaning) with no copay. The plan does not cover fluoride treatments, maxillofacial prosthetics, implant services, or orthodontics, while restorative services, adjunctive general services, endodontics, prosthodontics, fixed, and oral and maxillofacial surgery have a 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Freedom Plus (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Freedom Plus (HMO) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. Some services are not covered, including Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Freedom Plus (HMO) plan. Diagnostic Procedures/Tests have a $50 copay, while Lab Services have a $10 copay. Diagnostic Radiological Services have a copay of at most $200, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Freedom Plus (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Freedom Plus (HMO) plan, but the plan does not cover the Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services sub-services. There is a copay for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Freedom Plus (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The Freedom Plus (HMO) plan's "Other Services" benefit covers over-the-counter items, with a maximum of $70 every three months, and a meal benefit for chronic illness. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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