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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 2025, 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 2025.
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.
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.
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 a range of healthcare benefits with varying costs. For inpatient hospital stays, you'll pay a $340 copay per admission, while outpatient services have copays ranging from $35 to $200. Emergency services come with a $125 copay, and ambulance services also have a $125 copay. The plan covers primary care, specialist visits, and mental health services with a $20-$35 copay. It also includes vision and dental services, with eye exams at a $35 copay and dental services at a $15-$35 copay. Additionally, the plan covers hearing exams with a $35 copay, and offers coverage for hearing aids. Other benefits include home health services with no copay, and durable medical equipment with 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, each with a $340 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, along with Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services are covered by the Freedom Blue PPO Basic (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 $200 copay, ambulatory surgical center services have a $100 copay, and individual and group sessions for outpatient substance abuse have a copay between $35 and $35.
Partial Hospitalization See details
Partial Hospitalization is covered by the Freedom Blue PPO Basic (PPO) plan. There is no information about the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $125 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 services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Freedom Blue PPO Basic (PPO) plan. Emergency Services and Worldwide Emergency Transportation have a $125 copay, and Urgently Needed Services and Worldwide Urgent Coverage have a $50 copay; all services have no coinsurance.
Primary Care See details
The Freedom Blue PPO Basic (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, mental health specialty services with a $35 copay for individual and group sessions, podiatry services with a $35 copay for routine foot care, other health care professional services with a copay between $0 and $35, psychiatric services with a $35 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $50, and opioid treatment program services with a $35 copay. Routine chiropractic care is limited to 8 visits per year.
Preventive Services See details
Preventive services, including Medicare-covered services, annual physical exams, and additional preventive services, are covered. Additional preventive services may have a copay or coinsurance, and some services like Health Education, Counseling Services, and others are not covered.
Hearing Services See details
Hearing Services include a $35 copay for hearing exams, with coverage for Routine Hearing Exams limited to 1 visit per year. Prescription Hearing Aids have a maximum benefit of $500 per year, with a copay between $599 and $899 for Prescription Hearing Aids (all types), limited to 2 visits per year. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $35 copay, as well as coverage for eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $425 every year.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $35 copay, and Other Dental Services with a $15 copay. Some services are covered, including Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), and Adjunctive General Services. Fluoride Treatment, 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 by the Freedom Blue PPO Basic (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with between 0% and 20% coinsurance, and Other Medicare Part B Drugs with between 0% and 20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Basic (PPO) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
The Freedom Blue PPO Basic (PPO) plan covers Durable Medical Equipment (DME) with 20% coinsurance and no copay, and requires prior authorization. Prosthetics and Medical Supplies are covered with 20% coinsurance and no copay. Diabetic Equipment is covered, with 0-20% coinsurance and no copay for Diabetic Supplies, and 20% coinsurance and no copay for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $20, lab services with no copay, and radiological services with a copay between $25 and $150. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Freedom Blue PPO Basic (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Freedom Blue PPO Basic (PPO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are partially covered, 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. The plan offers a meal benefit for chronic illnesses, but does not have a maximum benefit coverage amount.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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