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Freedom Blue PPO Basic (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Basic (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 Basic (PPO) in 2026, please refer to our full plan details page.
Freedom Blue PPO Basic (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 Basic (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Freedom Blue PPO Basic (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 Basic (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $18.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Freedom Blue PPO Basic (PPO).
Additional Benefits
The Freedom Blue PPO Basic (PPO) plan offers affordable medical coverage with no copays for primary care doctor visits, home health services, and annual preventive physicals. For specialized care, members pay a $35 copay for specialist visits and a $340 copay per stay for inpatient hospital services, both featuring no coinsurance. Emergency services are covered with a $130 copay, which is waived if you are admitted to the hospital within three days. The plan also includes routine supplemental benefits, featuring a $35 copay for annual hearing and vision exams, alongside a $425 annual allowance for eyewear. Dental exams and cleanings are covered with no coinsurance, while other covered dental services require a $15 to $35 copay. Additionally, medical equipment and dialysis services require no copay and a 20% coinsurance, and members can access up to 24 one-way transportation trips per year to plan-approved locations with no copay.
Inpatient Hospital See details
Freedom Blue PPO Basic (PPO) covers inpatient hospital services with a $340 copay per stay and no coinsurance, although prior authorization is required. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Freedom Blue PPO Basic (PPO) covers outpatient services with no coinsurance, featuring a $200 copay for outpatient hospital and daily observation services, and a $100 copay for ambulatory surgical center services. Additionally, outpatient substance abuse services require a $35 copay per session, while outpatient blood services are fully covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Freedom Blue PPO Basic (PPO) covers partial hospitalization services in full, requiring no copay and no coinsurance from members.
Ambulance and Transportation Services See details
Freedom Blue PPO Basic (PPO) covers ground and air ambulance services with a $270 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
Emergency services are covered by Freedom Blue PPO Basic (PPO) with a $130 copay and no coinsurance, and the copay is waived if you are admitted to the hospital within three days. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $50, and $270 respectively.
Primary Care See details
Freedom Blue PPO Basic (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical and occupational therapies, and mental health services require a $35 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance for up to 8 routine visits per year (other chiropractic services are not covered), and telehealth benefits feature a $0 to $50 copay and no coinsurance.
Preventive Services See details
Freedom Blue PPO Basic (PPO) preventive services are partially covered, offering annual physical exams, kidney disease education, and screenings with no copay and no coinsurance. While remote access technologies ($0 to $35 copay) and home safety devices (20% coinsurance) are included, services like health education, in-home safety assessments, PERS, nutritional/dietary benefits, and alternative therapies are not covered.
Hearing Services See details
Freedom Blue PPO Basic (PPO) hearing services are partially covered, featuring one routine hearing exam per year for a $35 copay and no coinsurance, with no deductible. Prescription hearing aids are covered up to a $500 annual limit with no coinsurance and copays between $599 and $899, though OTC hearing aids, fitting evaluations, and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Freedom Blue PPO Basic (PPO), offering one routine annual eye exam with a $35 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is fully covered with no copay, no coinsurance, and no deductible, providing up to a $425 combined annual maximum for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Dental Services are partially covered under Freedom Blue PPO Basic (PPO), with Medicare-covered dental requiring a $35 copay and no coinsurance, and other covered dental services requiring a $15 copay and no coinsurance. While exams, cleanings, and x-rays are covered with no coinsurance, several services—including fluoride, restorative, endodontics, periodontics, prosthodontics, implants, and oral surgery—are not covered.
Home Infusion bundled Services See details
Freedom Blue PPO Basic (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Freedom Blue PPO Basic (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Freedom Blue PPO Basic (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays for all covered items. Members will pay a 20% coinsurance for most equipment, though diabetic supplies range from 0% coinsurance (no coinsurance) to 20% coinsurance, and prior authorization is required.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under Freedom Blue PPO Basic (PPO) with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic tests range from no copay to a $20 copay, outpatient X-rays require a $25 copay, and therapeutic and diagnostic radiological services have minimum copays of $60 and $150, respectively.
Home Health Services See details
Home Health Services are covered under Freedom Blue PPO Basic (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Freedom Blue PPO Basic (PPO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, but some services are not covered, specifically cardiac, intensive cardiac, pulmonary, and SET for PAD services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Freedom Blue PPO Basic (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Freedom Blue PPO Basic (PPO) partially covers other services, offering a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and other supplemental services are not covered.
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