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Freedom Blue PPO ValueRx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO ValueRx (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 ValueRx (PPO) in 2025, please refer to our full plan details page.
Freedom Blue PPO ValueRx (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 ValueRx (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 ValueRx (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 ValueRx (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $39.00. 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 ValueRx (PPO) plan has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for each prescription, which varies depending on the drug tier and pharmacy. For example, preferred generic drugs have a $13 copay at a preferred pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Freedom Blue PPO ValueRx (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. You'll have a copay for emergency services, primary care, and specialist visits, as well as hearing, vision, and dental services. The plan also covers home health services, skilled nursing facilities, and medical equipment with specific cost-sharing amounts. This plan provides coverage for ambulance services, diagnostic and radiological services, and preventive services. There is a $40 copay for routine hearing exams and a copay between $599 and $899 for prescription hearing aids. Vision services include eye exams with a $40 copay, and coverage for contact lenses, eyeglass lenses, and frames, with a maximum of $425 per year.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $245 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $245 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital and Observation Services have a $225 copay, while Ambulatory Surgical Center (ASC) Services have a $200 copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay between $40 and $40.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the Freedom Blue PPO ValueRx (PPO) plan. There is no information about the cost of this benefit, so details about the copay and coinsurance are not available.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Freedom Blue PPO ValueRx (PPO) plan. Ground and Air Ambulance Services have a copay of $260.00, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered under the Freedom Blue PPO ValueRx (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $5 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $5 copay, and Worldwide Emergency Transportation has a $260 copay; all have no coinsurance.
Primary Care See details
The Freedom Blue PPO ValueRx (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $40 copay, and mental health specialty services with a $40 copay for individual and group sessions. The plan also covers podiatry services with a $40 copay, other healthcare professional services with a copay between $0 and $40, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $40 copay.
Preventive Services See details
Preventive services are covered, including Medicare-covered zero-dollar preventive services, an annual physical exam, and additional preventive services. Additional preventive services may include a coinsurance of 20% for Home and Bathroom Safety Devices and Modifications, and a copay between $0 and $40 for Remote Access Technologies. Some services, such as Health Education, Counseling Services, and Telemonitoring Services, are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $40 copay, and prescription hearing aids with a copay between $599 and $899, up to a maximum of $500 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 eye exams with a $40 copay, contact lenses, eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum of $425 per year for both in and out-of-network services. Eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $40 copay, and Other Dental Services with a $15 copay. Oral exams, dental x-rays, prophylaxis (cleaning), and adjunctive general services are covered, but fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%; Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO ValueRx (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by Freedom Blue PPO ValueRx (PPO). Durable Medical Equipment (DME) has a 20% coinsurance, and requires authorization. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Equipment has a coinsurance that varies. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Freedom Blue PPO ValueRx (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $20, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at least $175, Therapeutic Radiological Services have a copay of at least $60, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Freedom Blue PPO ValueRx (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 with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The "Other Services" benefit for Freedom Blue PPO ValueRx (PPO) does not cover 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 covers a meal benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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