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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 2025, 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 2025.
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 $134.00. 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 Standard (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In 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 standard generic drugs, the copay is $45 at a preferred pharmacy and $47 at a standard pharmacy. For preferred brand drugs, the copay is $95 at a preferred pharmacy and $100 at a standard pharmacy. For non-preferred drugs, you pay 33% coinsurance.
Additional Benefits
The Freedom Blue PPO Standard (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $475 copay, while outpatient services range from $35 to $200. Emergency services will cost $125, and ambulance services have a $215 copay. Preventive, vision, and hearing services are included, with copays for exams and hearing aids. Dental services are available with copays, and home health services and partial hospitalization have no copay. The plan also covers a variety of other services with associated copays or coinsurance, but does not cover cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, and require prior authorization. For Inpatient Hospital-Acute, there is a $475 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, there is also a $475 copay per admission or stay, while additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, have a $200 copay. Ambulatory Surgical Center (ASC) services have a $150 copay. Outpatient Substance Abuse Services, including individual and group sessions, have a copay between $35.00 and $35.00. Outpatient Blood Services are also covered, with a waived three (3) pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Freedom Blue PPO Standard (PPO) plan. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $215 copay for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year, but transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage have a copay of $125, $5, $125, and $5 respectively, with no coinsurance. Worldwide Emergency Transportation has a copay of $215 with no coinsurance.
Primary Care See details
Freedom Blue PPO Standard (PPO) 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, podiatry services with a $35 copay, other health care professional services with a copay between $0-$35, psychiatric services with a $35 copay, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0-$35, and opioid treatment program services with a $35 copay. Routine chiropractic care is limited to 8 visits per year.
Preventive Services See details
The Freedom Blue PPO Standard (PPO) plan covers preventive services, including annual physical exams and other preventive services. The plan's additional preventive services have a coinsurance of 20% for home and bathroom safety devices and modifications, and a copay between $0 and $35 for remote access technologies, while certain services like health education and counseling services are not covered.
Hearing Services See details
Hearing services for the Freedom Blue PPO Standard (PPO) plan include routine hearing exams with a $35 copay, and prescription hearing aids with a copay between $599 and $899 with a maximum benefit of $500 per year. Fitting/evaluation for hearing aids, 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 are covered, including routine eye exams with a $35 copay, contact lenses, eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum plan benefit coverage of $425.00 per year, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $35 copay, and Other Dental Services with a $15 copay. Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), and Adjunctive General Services are covered, while 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 Standard (PPO) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Standard (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies, including Medicare-covered prosthetic devices and medical supplies, with 20% coinsurance. Diabetic Equipment is covered, with Diabetic Supplies incurring between 0-20% coinsurance and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $15, and lab services with no copay. This plan also covers diagnostic radiological services with a copay of at least $125, therapeutic radiological services with a copay of at least $60, and outpatient X-ray services with a $20 copay.
Home Health Services See details
Home Health Services are covered by the Freedom Blue PPO Standard (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 in practice, none of the sub-services are covered. The plan does not offer coverage for 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 under the Freedom Blue PPO Standard (PPO) plan, with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered, including 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. The plan does cover a meal benefit for a chronic illness, but does not have a maximum plan benefit coverage amount.
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