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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 2026, 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 2026.
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 $248.00. 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) Medicare plan offers a $0 drug deductible, allowing your prescription coverage to start immediately with no initial deductible to meet. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies, and no copay for a 3-month supply through preferred mail order. Tier 2 generic drugs are also budget-friendly, starting at a $13 copay for a 1-month supply at a preferred pharmacy. Tier 3 preferred brand drugs carry a $45 copay for a 1-month supply at preferred pharmacies, while Tier 4 non-preferred drugs require a $95 copay. Specialty drugs in Tier 5 are subject to a 33% coinsurance for a 1-month supply regardless of whether you use preferred or standard pharmacies and mail order. To maximize your savings under this plan, utilizing preferred pharmacies and preferred mail-order services for your prescriptions is highly recommended.
Additional Benefits
Freedom Blue PPO Classic (PPO) offers comprehensive medical coverage with no copay for primary care visits and routine preventive services. Specialized care is highly accessible, featuring a $25 copay for specialist visits and a $210 copay per admission for inpatient hospital stays with no coinsurance. Emergency care is covered with a $130 copay, which is waived if admitted, while urgent care services require a $50 copay. The plan also includes key supplemental benefits, such as routine dental exams and cleanings for a $15 copay, routine eye exams for a $25 copay, and up to $425 annually for eyewear with no copay. Additionally, members can access up to 24 one-way transportation trips per year to plan-approved locations with no copay. For medical equipment and dialysis services, there are no copays, though a 20 percent coinsurance applies.
Inpatient Hospital See details
Freedom Blue PPO Classic (PPO) covers inpatient acute and psychiatric hospital stays with a $210 copay per admission and no coinsurance, subject to prior authorization. While unlimited additional days are covered for acute stays with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Freedom Blue PPO Classic (PPO) with no coinsurance for all covered services, featuring a $150 copay for outpatient hospital and daily observation services, and a $75 copay for ambulatory surgical center services. Additionally, individual and group outpatient substance abuse sessions require a $25 copay, while outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Freedom Blue PPO Classic (PPO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Freedom Blue PPO Classic (PPO) covers ground and air ambulance services with a $255 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Freedom Blue PPO Classic (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within three days. Urgently needed services have a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $50 to $255.
Primary Care See details
Freedom Blue PPO Classic (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $25 copay and no coinsurance. Chiropractic care is partially covered, offering routine visits for a $15 copay and no coinsurance, though other chiropractic services are not covered. Most other covered benefits, such as podiatry and psychiatric services, feature a $25 copay and no coinsurance.
Preventive Services See details
Freedom Blue PPO Classic (PPO) offers preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, and other routine screenings. Additional preventive benefits are partially covered, including memory fitness, remote access technologies (with a $0 to $25 copay and no coinsurance), and home safety devices (with 20% coinsurance and no copay), though services like health education, personal emergency response systems, and nutritional/dietary benefits are not covered.
Hearing Services See details
Hearing services are partially covered by Freedom Blue PPO Classic (PPO), which features routine hearing exams for a $25 copay and no coinsurance, alongside prescription hearing aids with a $599 to $899 copay, no coinsurance, and a $500 annual maximum. Fitting and evaluation exams, over-the-counter (OTC) hearing aids, and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Freedom Blue PPO Classic (PPO) offers partially covered vision services, which include one routine eye exam per year for a $25 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a combined maximum of $425 annually for contacts, eyeglasses, and upgrades.
Dental Services See details
Freedom Blue PPO Classic (PPO) partially covers dental services, offering Medicare-covered dental services for a $25.00 copay and no coinsurance, and other covered services like exams, cleanings, and x-rays for a $15.00 copay and no coinsurance. Adjunctive general services have no copay and no coinsurance, but fluoride treatments, restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Freedom Blue PPO Classic (PPO) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs feature no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Classic (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Freedom Blue PPO Classic (PPO) covers medical equipment, prosthetics, and diabetic supplies with no copays, though a 20% coinsurance applies to most items. Covered diabetic supplies feature coinsurance ranging from no coinsurance up to 20% from specified manufacturers, with prior authorization required across all categories.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Freedom Blue PPO Classic (PPO) with no coinsurance, though prior authorization is required. Under this plan, lab services have no copay, diagnostic tests range from no copay up to $10, outpatient x-rays have a $15 copay, and diagnostic and therapeutic radiological services require minimum copays of $100 and $60, respectively.
Home Health Services See details
Freedom Blue PPO Classic (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Freedom Blue PPO Classic (PPO) does not cover Cardiac Rehabilitation Services, as all associated sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Freedom Blue PPO Classic (PPO) covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Freedom Blue PPO Classic (PPO) partially covers other services, offering a chronic illness meal benefit with no copay and no coinsurance. Acupuncture, Over-the-Counter (OTC) items, and other supplemental services are not covered.
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