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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 West Central 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 $220.00. 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at preferred pharmacies, while standard pharmacies charge a $5 copay for a 1-month supply. Tier 2 generic medications cost a $13 copay for a 1-month supply at preferred pharmacies and $19 at standard pharmacies. Tier 3 preferred brand drugs require a $45 copay at preferred pharmacies, while Tier 4 non-preferred drugs carry a $95 copay for a 1-month supply. For specialty medications in Tier 5, you will pay a 33% coinsurance regardless of whether you use a preferred or standard pharmacy. You can also save on mail-order prescriptions, with preferred mail-order services offering lower copays for 3-month supplies across most tiers.
Additional Benefits
The Freedom Blue PPO Classic (PPO) plan offers robust coverage with no copays or coinsurance for primary care visits, preventive services, and home health care. For specialized care, members pay a $25 copay for specialist visits, while inpatient hospital stays require a $210 copay per admission with no coinsurance. Emergency care is accessible with a $130 copay, which is waived if admitted, and urgent care carries a $50 copay. This plan also features supplemental benefits, including no copays for preventive dental cleanings and up to a $425 annual eyewear allowance with no deductible. Routine hearing and vision exams require a $25 copay, and skilled nursing facility stays have no copay for the first 20 days. Additionally, medical equipment and dialysis services are covered with no copay and a standard 20% coinsurance.
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. This benefit is partially covered as upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered, though unlimited additional acute days are included with no copay.
Outpatient Services See details
Freedom Blue PPO Classic (PPO) covers outpatient hospital and observation services with a $150 copay, and ambulatory surgical center services with a $75 copay, all with no coinsurance. Outpatient substance abuse sessions have a $25 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Freedom Blue PPO Classic (PPO) plan 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 $325 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while 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, which is waived if admitted to the hospital within three days, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $50, and $325, respectively.
Primary Care See details
Freedom Blue PPO Classic (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, and mental health services require a $25 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance for routine care, but other chiropractic services are not covered.
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 standard screenings. Additional benefits are partially covered, including remote access technologies with a $0 to $25 copay (no coinsurance) and home safety devices with 20% coinsurance (no copay), while health education, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Freedom Blue PPO Classic (PPO) partially covers hearing services, offering one annual routine hearing exam for a $25 copay and no coinsurance, and prescription hearing aids with copays ranging from $599 to $899, no coinsurance, and a $500 annual maximum benefit. Fitting and evaluation services, OTC hearing aids, and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Freedom Blue PPO Classic (PPO) partially covers eye exams with a $25 copay, no coinsurance, and no deductible for one routine exam per year, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $425 combined annual allowance for contacts, lenses, frames, and upgrades.
Dental Services See details
Freedom Blue PPO Classic (PPO) offers partially covered dental services, featuring Medicare dental services for a $25.00 copay and other dental services for a $15.00 copay, both with no coinsurance. Covered preventive care like oral exams, cleanings, and dental X-rays have no coinsurance, but fluoride, 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, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, require no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
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 copay and a 20% coinsurance for most items. Diabetic supplies specifically have no copay and range from no coinsurance up to 20% coinsurance, with prior authorization required for all medical equipment.
Diagnostic and Radiological Services See details
Freedom Blue PPO Classic (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay, outpatient x-rays carry a $15 copay, diagnostic tests range from a $0 to $10 copay, and diagnostic and therapeutic radiological services require minimum copays of $100 and $60 respectively.
Home Health Services See details
Home Health Services are covered under the Freedom Blue PPO Classic (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Freedom Blue PPO Classic (PPO) covers some services under Cardiac Rehabilitation Services with no copay and no coinsurance. However, 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 Freedom Blue PPO Classic (PPO) with no coinsurance, requiring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Freedom Blue PPO Classic (PPO) partially covers other services, which includes a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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