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Freedom Blue PPO Standard (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Standard (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 Standard (PPO) in 2026, please refer to our full plan details page.
Freedom Blue PPO Standard (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 Standard (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 Standard (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 Standard (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $121.00. 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.
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 Standard (PPO) plan offers affordable prescription drug coverage with a $0 drug deductible, allowing your benefits to start immediately. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies and through preferred mail order. Tier 2 generic drugs are also highly accessible, with copays starting at $13 for a 1-month supply at preferred pharmacies and $27 for a 3-month supply through preferred mail order. Higher-tier prescription costs vary based on the drug classification and your choice of pharmacy. Tier 3 preferred brand drugs carry a $45 copay for a 1-month supply at preferred pharmacies, whereas Tier 4 non-preferred drugs require a $95 copay. For Tier 5 specialty medications, you will pay a 33% coinsurance for a 1-month supply at both standard and preferred pharmacies.
Additional Benefits
The Freedom Blue PPO Standard (PPO) plan offers comprehensive medical coverage featuring no copay for primary care doctor visits, preventive care services, and home health care. For specialized care, members pay a $35 copay for specialist visits, as well as routine dental, vision, and hearing exams. Inpatient hospital stays require a $475 copay per admission, while outpatient surgery and emergency room visits carry copays ranging from $130 to $200 with no coinsurance. This plan also includes extra benefits, such as up to 24 one-way transportation trips per year with no copay and up to $425 annually for eyewear. For medical equipment, prosthetics, and dialysis services, members will pay a 20% coinsurance with no copay. Skilled nursing facility stays are covered with no copay for the first 20 days, and diagnostic lab services are also available with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Freedom Blue PPO Standard (PPO) with a $475 copay per admission and no coinsurance for both acute and psychiatric stays, subject to prior authorization. Unlimited additional days are covered for acute stays with no copay, but non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Freedom Blue PPO Standard (PPO) covers outpatient hospital and observation services for a $200 copay with no coinsurance, and ambulatory surgical center services for a $150 copay with no coinsurance. Outpatient substance abuse services require a $35 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Freedom Blue PPO Standard (PPO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Freedom Blue PPO Standard (PPO) covers ambulance services with a $260 copay and no coinsurance for both ground and air transport, subject to prior authorization. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while rides to any health-related location are not covered.
Emergency Services See details
Freedom Blue PPO Standard (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $50 to $260.
Primary Care See details
Freedom Blue PPO Standard (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, therapy, and mental health services generally require a $35 copay and no coinsurance. Chiropractic care is partially covered, offering routine services with a $15 copay and no coinsurance while excluding other chiropractic services, and telehealth benefits are available with a $0 to $50 copay and no coinsurance.
Preventive Services See details
Freedom Blue PPO Standard (PPO) provides preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, and other screenings. Additional benefits are partially covered, featuring memory fitness, remote access technologies with a $0 to $35 copay and no coinsurance, and home safety devices with a 20% coinsurance and no copay. However, sub-services such as health education, PERS, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Freedom Blue PPO Standard (PPO), featuring routine hearing exams for a $35 copay and no coinsurance, alongside prescription hearing aids with a $599 to $899 copay, no coinsurance, and a $500 annual limit. Hearing aid fittings and evaluations, OTC hearing aids, and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Freedom Blue PPO Standard (PPO) offers partially covered vision services, which include one routine eye exam per year for a $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a $425 annual combined maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Freedom Blue PPO Standard (PPO), featuring a $35 copay and no coinsurance for Medicare-covered dental, and a $15 copay with no coinsurance for other covered dental services. While exams, cleanings, x-rays, and adjunctive general services (which have no copay and no coinsurance) are covered, 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 Standard (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B drugs such as chemotherapy and insulin are covered with 0% to 20% coinsurance (or no coinsurance at the minimum), with insulin carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered under Freedom Blue PPO Standard (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Freedom Blue PPO Standard (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance, though diabetic supplies range from no coinsurance to 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Freedom Blue PPO Standard (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Diagnostic tests range from no copay to a $15 copay, lab services have no copay, outpatient X-rays require a $20 copay, and therapeutic and diagnostic radiological services have copays starting at $60 and $125, respectively.
Home Health Services See details
Freedom Blue PPO Standard (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Freedom Blue PPO Standard (PPO) does not cover Cardiac Rehabilitation Services, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Freedom Blue PPO Standard (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100 per stay. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Freedom Blue PPO Standard (PPO) partially covers other services, offering a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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