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Freedom Blue PPO Deluxe (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Deluxe (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 Deluxe (PPO) in 2025, please refer to our full plan details page.
Freedom Blue PPO Deluxe (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2025 to people living in Central and Northeastern 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 Deluxe (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 Deluxe (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 Deluxe (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 Deluxe (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, the copay is $13 at a preferred pharmacy and $19 at a standard pharmacy. For preferred brand drugs, the copay is $95 at a preferred pharmacy and $100 at a standard pharmacy. After your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Freedom Blue PPO Deluxe (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $235 copay per admission, while outpatient services like doctor visits and therapy sessions have copays typically ranging from $20 to $30. Emergency services have a $125 copay, and ambulance services have a $140 copay. Preventive services and primary care physician services have no copay. Vision services include eye exams for a $30 copay, and hearing services include hearing exams for a $30 copay, with hearing aids covered up to $500 per year. The plan also covers dental, home health, and skilled nursing facility services, with some copays and coinsurance applying depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric care, are covered by the Freedom Blue PPO Deluxe (PPO) plan. For both Inpatient Hospital-Acute and Inpatient Hospital-Psychiatric services, there is a $235 copay 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, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital-Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Freedom Blue PPO Deluxe (PPO) plan, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $175 copay, ambulatory surgical center services have a $100 copay, and individual and group sessions for outpatient substance abuse have a $30 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Freedom Blue PPO Deluxe (PPO) plan.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $140 copay for both ground and air ambulance services. Transportation Services to plan-approved health-related locations are covered for up to 24 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Freedom Blue PPO Deluxe (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $5 copay, while Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $5 copay, and Worldwide Emergency Transportation has a $140 copay; all services have no coinsurance.
Primary Care See details
The Freedom Blue PPO Deluxe (PPO) plan covers primary care, including primary care physician services, with no copay. Chiropractic services are covered with a $20 copay, and routine chiropractic care has a $20 copay for up to 10 visits per year. Occupational therapy services are covered with a $30 copay. Physician specialist services, physical therapy, and speech-language pathology services have a $30 copay. Mental health services, including individual and group sessions, have a $30 copay. Podiatry services and other health care professional services have a $30 copay. Psychiatric services, including individual and group sessions, have a $30 copay. Additional telehealth benefits have a copay between $0-$30, and opioid treatment program services have a $30 copay.
Preventive Services See details
The Freedom Blue PPO Deluxe (PPO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, kidney disease education, and other preventive services with no copay. Additional preventive services such as Home and Bathroom Safety Devices and Modifications have a 20% coinsurance. Some services, like Health Education, In-Home Safety Assessment, and Counseling Services, are not covered.
Hearing Services See details
Hearing services with Freedom Blue PPO Deluxe (PPO) include routine hearing exams for a $30 copay, and prescription hearing aids with a maximum benefit of $500 per year and a copay between $399 and $699. Fitting/evaluation for hearing aids, prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $30 copay. Eyewear is covered with a combined maximum of $425 per year for both in-network and out-of-network services, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Freedom Blue PPO Deluxe (PPO) plan covers Medicare Dental Services with a $30 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, Restorative Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), 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 the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Deluxe (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $10, Lab Services with no copay, Diagnostic Radiological Services with a copay of at most $75, Therapeutic Radiological Services with a copay of at most $60, and Outpatient X-Ray Services with a $10 copay. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by the Freedom Blue PPO Deluxe (PPO) plan 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 technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is no copay or coinsurance for these services.
Skilled Nursing Facility (SNF) See details
The Freedom Blue PPO Deluxe (PPO) plan covers Skilled Nursing Facility (SNF) services, but requires prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.00.
Other Services See details
Other Services includes a meal benefit, but 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. Meal benefits are offered for a chronic illness.
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