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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 2026, 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 2026.
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 $226.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $19.00. You must continue to pay paying your reduced 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies, or for a 3-month supply via preferred mail order. Tier 2 generic drugs cost as little as a $13 copay for a 1-month supply at preferred pharmacies, compared to a $19 copay at standard pharmacies. Tier 3 preferred brand drugs require a $45 copay for a 1-month supply at preferred pharmacies, while Tier 4 non-preferred drugs carry a $95 copay. Specialty medications in Tier 5 require a 33% coinsurance for a 1-month supply across all pharmacy and mail-order options. Utilizing preferred pharmacies and preferred mail-order services offers the lowest out-of-pocket costs for your prescription medications under this plan.
Additional Benefits
The Freedom Blue PPO Deluxe (PPO) plan offers robust healthcare coverage with predictable, low-cost options for major medical needs. Members benefit from no copay for primary care doctor visits and preventive services, while specialist visits and routine eye and hearing exams require a straightforward $30 copay with no coinsurance. Inpatient hospital admissions have a $235 copay, outpatient services require a $175 copay, and emergency room visits feature a $130 copay, all with no coinsurance. Additionally, the plan covers home health services and diagnostic lab tests with no copay and no coinsurance, while routine dental cleanings require no coinsurance. For specialized care, medical equipment and dialysis services are covered with no copay and a 20 percent coinsurance. Members also receive extra perks like up to 24 one-way transportation trips per year and a chronic illness meal benefit with no copay and no coinsurance.
Inpatient Hospital See details
Freedom Blue PPO Deluxe (PPO) covers inpatient acute and psychiatric hospital stays with a $235 copayment per admission and no coinsurance, requiring prior authorization. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered.
Outpatient Services See details
Freedom Blue PPO Deluxe (PPO) covers outpatient hospital and observation services with a $175 copay and no coinsurance, and ambulatory surgical center services with a $100 copay and no coinsurance. Outpatient substance abuse sessions require a $30 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Freedom Blue PPO Deluxe (PPO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Freedom Blue PPO Deluxe (PPO) covers ground and air ambulance services with a $275 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 Deluxe (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if admitted to the hospital within three days. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $50, and $275 respectively.
Primary Care See details
Freedom Blue PPO Deluxe (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, therapies, mental health, podiatry, and opioid treatment require a $30 copay and no coinsurance. Chiropractic services are partially covered, featuring routine care with a $15 copay and no coinsurance for up to 10 visits yearly, but other chiropractic services are not covered. Telehealth benefits are also available with a $0 to $50 copay and no coinsurance.
Preventive Services See details
Freedom Blue PPO Deluxe (PPO) offers partially covered preventive services, featuring annual physical exams, kidney disease education, and routine screenings with no copay and no coinsurance. While remote access technologies ($0 to $30 copay) and home safety devices (20% coinsurance) are covered, several sub-services such as health education, personal emergency response systems, and in-home safety assessments are not covered.
Hearing Services See details
Freedom Blue PPO Deluxe (PPO) offers partially covered hearing services with no deductible, including one annual routine hearing exam for a $30 copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and copays ranging from $399 to $699 up to a $500 annual limit, though fitting/evaluations, OTC hearing aids, and inner, outer, or over-the-ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by Freedom Blue PPO Deluxe (PPO), offering one annual routine eye exam with a $30 copay, no coinsurance, and no deductible, though other eye exams are not covered. Covered eyewear, including contacts, lenses, frames, and upgrades, has no copay, no coinsurance, and no deductible, up to a $425 combined annual limit.
Dental Services See details
Dental services are partially covered by Freedom Blue PPO Deluxe (PPO), offering Medicare-covered dental services for a $30.00 copay and no coinsurance, and other dental services for a $15.00 copay and no coinsurance. While routine cleanings, oral exams, and X-rays are covered with no coinsurance, this plan does not cover fluoride, restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, or orthodontics.
Home Infusion bundled Services See details
Freedom Blue PPO Deluxe (PPO) covers Home Infusion bundled Services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and a coinsurance of up to 20%.
Dialysis Services See details
Freedom Blue PPO Deluxe (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Freedom Blue PPO Deluxe (PPO) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance for most items. Covered diabetic supplies feature no coinsurance to 20% coinsurance depending on the manufacturer, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Freedom Blue PPO Deluxe (PPO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. There is no copay for lab services, a $0 to $10 copay for diagnostic procedures, a $10 copay for outpatient X-rays, and minimum copays of $60 for therapeutic radiology and $75 for diagnostic radiology.
Home Health Services See details
Home health services are covered under the Freedom Blue PPO Deluxe (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Freedom Blue PPO Deluxe (PPO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, 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 Deluxe (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required before admission, and additional days beyond standard Medicare-covered days are not covered.
Other Services See details
Other Services for Freedom Blue PPO Deluxe (PPO) are partially covered, featuring a chronic illness meal benefit with no copay and no coinsurance, though acupuncture and over-the-counter (OTC) items are not covered.
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