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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 2026, 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 2026.
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 $66.00. 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) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at preferred pharmacies, as well as for a 3-month supply through preferred mail order. Tier 2 generic drugs are also highly affordable, with copays starting at $13 for a 1-month supply when using a preferred pharmacy. Tier 3 preferred brand drugs carry a $45 copay for a 1-month supply at preferred pharmacies, compared to $47 at standard pharmacies. For higher-tier prescriptions, cost-sharing transitions to coinsurance, with a 30% coinsurance rate for Tier 4 non-preferred drugs and 33% coinsurance for Tier 5 specialty drugs. Utilizing preferred pharmacies and preferred mail-order options provides the most cost-effective rates under this plan.
Additional Benefits
The Freedom Blue PPO ValueRx (PPO) Medicare plan offers robust medical coverage featuring predictable out-of-pocket costs with no coinsurance for many core services. Beneficiaries enjoy no copay and no coinsurance for primary care doctor visits, annual physical exams, and home health services. Inpatient hospital stays require a $245 daily copay for days one through five, followed by no copay for days six through ninety, while emergency room visits carry a $130 copay. For supplemental care, the plan provides routine dental cleanings and exams with no copay, alongside a $425 annual allowance for eyewear with no copay or coinsurance. Routine vision and hearing exams are available for a $40 copay, whereas prescription hearing aids feature copays ranging from $599 to $899. Additionally, diagnostic lab work is covered with no copay, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Freedom Blue PPO ValueRx (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring prior authorization and a daily copay of $245 for days 1 through 5, and no copay for days 6 through 90. While unlimited additional acute hospital days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Freedom Blue PPO ValueRx (PPO) covers outpatient services with no coinsurance, featuring a $225 copay for outpatient hospital and observation services, and a $200 copay for ambulatory surgical center services. Outpatient substance abuse services require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Freedom Blue PPO ValueRx (PPO) covers partial hospitalization services with no copay and no coinsurance. You will pay nothing out of pocket for these covered psychiatric day treatment services under this plan.
Ambulance and Transportation Services See details
Freedom Blue PPO ValueRx (PPO) covers emergency ground and air ambulance services with a $270 copay and no coinsurance. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Freedom Blue PPO ValueRx (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 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 ValueRx (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits, therapy, and mental health services require a $40 copay and no coinsurance. Chiropractic services are partially covered, featuring routine care for a $15 copay and no coinsurance for up to 6 visits per year while other chiropractic services are not covered, and telehealth benefits are available with a $0 to $50 copay and no coinsurance.
Preventive Services See details
Freedom Blue PPO ValueRx (PPO) partially covers preventive services, providing annual physical exams, kidney disease education, and other routine screenings with no copay and no coinsurance. While remote access technologies (copay of $0 to $40) and home safety devices (20% coinsurance) are covered, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, or counseling.
Hearing Services See details
Freedom Blue PPO ValueRx (PPO) offers partially covered hearing services, which include one annual routine hearing exam for a $40 copay and no coinsurance. Prescription hearing aids are covered with a copay ranging from $599 to $899 and no coinsurance up to a $500 annual maximum, but fitting or evaluations, over-the-counter (OTC) hearing aids, and inner, outer, or over-the-ear hearing aids are not covered.
Vision Services See details
Freedom Blue PPO ValueRx (PPO) provides coverage for vision services, featuring one routine eye exam per year with a $40 copay and no coinsurance, though other eye exam services are not covered. Eyewear, including contacts, frames, lenses, and upgrades, is covered with no copay, no coinsurance, and no deductible, up to a combined annual maximum benefit of $425.
Dental Services See details
Freedom Blue PPO ValueRx (PPO) partially covers dental services, offering Medicare-covered dental services for a $40 copay and no coinsurance, and other dental services for a $15 copay and no coinsurance. While exams, cleanings, and x-rays are covered with no coinsurance, and adjunctive general services feature no copay and no coinsurance, the plan does not cover fluoride, restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, or orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Freedom Blue PPO ValueRx (PPO) with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Freedom Blue PPO ValueRx (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Freedom Blue PPO ValueRx (PPO) with no copay and generally 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 ValueRx (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Outpatient lab services have no copay, diagnostic tests have a $0 to $20 copay, outpatient X-rays cost $25, and diagnostic and therapeutic radiological services require minimum copays of $175 and $60, respectively.
Home Health Services See details
Freedom Blue PPO ValueRx (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Freedom Blue PPO ValueRx (PPO) offers coverage for some Cardiac Rehabilitation Services with no copay and no coinsurance, though specific services including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered.
Skilled Nursing Facility (SNF) See details
Freedom Blue PPO ValueRx (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services under the Freedom Blue PPO ValueRx (PPO) plan are partially covered, featuring a limited-duration meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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