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Freedom Blue PPO Classic (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Classic (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Freedom Blue PPO Classic (PPO) in 2025, please refer to our full plan details page.
Freedom Blue PPO Classic (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2025 to people living in Southwestern PA. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Freedom Blue PPO Classic (PPO) 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 Blue PPO Classic (PPO).
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 Blue PPO Classic (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $252.00. 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 combined Maximum Out-Of-Pocket cost of $8950.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8950.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Blue PPO Classic (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for each prescription, depending on the drug tier and pharmacy. For example, preferred generic drugs have a $13 copay at preferred pharmacies and $19 at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D is $70.20.
Additional Benefits
The Freedom Blue PPO Classic (PPO) plan offers a range of benefits, including inpatient hospital stays with a $210 copay per admission, and outpatient services with a $150 copay. Ambulance services have a $115 copay, and emergency services have a $125 copay. Primary care, vision, and dental services are also covered, with varying copays for different services. This plan also includes coverage for preventive services, hearing services, and medical equipment. You will pay a coinsurance for some services like dialysis, and durable medical equipment. The plan covers skilled nursing facility stays, and home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a copay of $210.00 per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, have a $150 copay. Ambulatory Surgical Center (ASC) Services have a $75 copay, while individual and group sessions for outpatient substance abuse have a copay between $25 and $25. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Freedom Blue PPO Classic (PPO) plan. The specific costs associated with this benefit are not detailed in the provided information.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a $115 copay. Transportation Services to a plan-approved health-related location are also covered for up to 24 one-way trips per year, but 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 under the Freedom Blue PPO Classic (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $5 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $5 copay, and Worldwide Emergency Transportation has a $115 copay.
Primary Care See details
The Freedom Blue PPO Classic (PPO) plan covers primary care physician services, chiropractic services (with a $15 copay), occupational therapy services (with a $25 copay), physician specialist services (with a $25 copay), mental health specialty services (minimum $25 copay), podiatry services (minimum $25 copay), other health care professional services (minimum $0 copay, maximum $25 copay), psychiatric services (minimum $25 copay), physical therapy and speech-language pathology services (with a $25 copay), additional telehealth benefits (copay $0-$25), and opioid treatment program services (minimum $25 copay). Routine chiropractic care and routine foot care are also covered, with a $15 copay for routine chiropractic care and a $25 copay for routine foot care.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams, additional preventive services, kidney disease education, and other preventive services. Additional preventive services may have coinsurance, and Remote Access Technologies may have a copay between $0 and $25; however, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, telemonitoring services, and counseling services are not covered. Home and bathroom safety devices and modifications have 20% coinsurance.
Hearing Services See details
Hearing Services include Routine Hearing Exams with a $25 copay, and Prescription Hearing Aids with a copay between $599 and $899, with a maximum benefit of $500 per year. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Over the Ear hearing aids, and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services includes coverage for routine eye exams with a $25 copay. Eyewear is covered with a combined maximum benefit of $425 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a $25 copay, and Other Dental Services with a $15 copay. Oral exams, dental x-rays, prophylaxis (cleaning), and adjunctive general services are covered, but fluoride treatment is not. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Freedom Blue PPO Classic (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Freedom Blue PPO Classic (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures and tests, and lab services, are covered. Diagnostic procedures and tests have a copay between $0 and $10, lab services have no copay, diagnostic radiological services have a copay of at least $100, therapeutic radiological services have a copay of at least $60, and outpatient X-ray services have a $15 copay.
Home Health Services See details
Home Health Services are covered by Freedom Blue PPO Classic (PPO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Freedom Blue PPO Classic (PPO) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Freedom Blue PPO Classic (PPO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for Skilled Nursing Facility (SNF) and Non-Medicare-covered stays for Skilled Nursing Facility (SNF) are not covered.
Other Services See details
Other services, including acupuncture, over-the-counter items, 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. The plan offers a meal benefit for a chronic illness.
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