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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 West Central 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 $224.00. 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. During the initial coverage phase, you will pay a copay for your prescriptions, which varies depending on the drug tier and pharmacy. For example, preferred generic drugs have a $13 copay at preferred pharmacies and a $19 copay at standard pharmacies, while preferred brand drugs have a $95 copay at preferred pharmacies and a $100 copay at standard pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Freedom Blue PPO Classic (PPO) plan offers a range of benefits, including inpatient hospital stays with a $210 copay per admission. Outpatient services come with copays that vary, such as $150 for hospital services and $75 for ambulatory surgical centers. Additionally, the plan covers ambulance services with a $165 copay and provides transportation to health-related locations, limited to 24 one-way trips per year. This plan includes coverage for primary care, preventive services, hearing and vision exams, and dental services with varying copays. Home health services have no copay, while skilled nursing facilities have no copay for the first 20 days and a $214 copay for days 21-100. The plan also covers medical equipment and diagnostic services with copays and coinsurance, and offers a meal benefit for chronic illnesses, although some services like cardiac rehabilitation and certain other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Freedom Blue PPO Classic (PPO) plan. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $210 copay per admission or stay.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and outpatient substance abuse services, are covered by the Freedom Blue PPO Classic plan. Outpatient Hospital Services and Observation Services have a $150 copay, while Ambulatory Surgical Center (ASC) Services have a $75 copay. Individual and group sessions for outpatient substance abuse have a copay between $25 and $25.
Partial Hospitalization See details
Partial Hospitalization is covered by the Freedom Blue PPO Classic (PPO) plan. There is no information about the cost of this benefit, so the copay and coinsurance are unknown.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $165 copay. Transportation Services to plan-approved health-related locations are covered for up to 24 one-way trips per year. 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 has a $125 copay, Urgently Needed Services has a $5 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $5 copay, and Worldwide Emergency Transportation has a $165 copay.
Primary Care See details
The Freedom Blue PPO Classic (PPO) plan covers primary care, including physician services, chiropractic services with a $15 copay, occupational therapy with a $25 copay, and specialist services with a $25 copay. Mental health, podiatry, other health care professional, psychiatric services, physical therapy, speech-language pathology, additional telehealth, and opioid treatment program services are also covered with varying copays up to $25.
Preventive Services See details
Preventive Services, including Medicare-covered services and annual physical exams, are covered by the Freedom Blue PPO Classic (PPO) plan. Additional preventive services include coverage for Remote Access Technologies with a copay between $0 and $25, and Home and Bathroom Safety Devices and Modifications with 20% coinsurance. Some services, such as Health Education, Counseling Services, and several others, are not covered.
Hearing Services See details
Hearing exams are covered with a $25 copay, and prescription hearing aids are covered with a copay between $599 and $899, while fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered. Routine hearing exams are limited to 1 per year.
Vision Services See details
Vision Services include coverage for eye exams with a $25 copay, and also cover routine eye exams once per year. Eyewear is covered up to a combined maximum of $425 per year, and also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services include a $25 copay for Medicare Dental Services and a $15 copay for Other Dental Services. Oral Exams, Dental X-Rays, and Prophylaxis (Cleaning) are covered, but Fluoride Treatment is not. Orthodontic Services are covered, but 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, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Classic (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Supplies have between 0% and 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $10, and lab services with no copay. Diagnostic Radiological Services have a minimum copay of $100, Therapeutic Radiological Services have a minimum copay of $60, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Freedom Blue PPO Classic (PPO) plan with no copay and no coinsurance, though authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Freedom Blue PPO Classic (PPO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
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. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered, 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. The plan does provide a Meal Benefit for a chronic illness, but does not have a maximum coverage amount.
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