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Freedom Blue PPO Select (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Select (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 Select (PPO) in 2025, please refer to our full plan details page.
Freedom Blue PPO Select (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2025 to people living in Southwestern 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 Select (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 Select (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 Select (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $139.00. 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 Select (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 each drug tier. For example, preferred generic drugs have a $13 copay at a preferred pharmacy, while standard generic drugs have a $45 copay. Non-preferred drugs have a 33% coinsurance. 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 Select (PPO) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient hospital stays with a $350 copay per admission, along with outpatient services, emergency services, and primary care visits, each with varying copays. Additionally, the plan provides coverage for vision, hearing, and dental services, including eye exams, hearing exams, and dental cleanings, all with associated copays. This plan also covers home health services with no copay, and skilled nursing facility stays with a copay after the first 20 days. Other notable benefits include ambulance and transportation services, preventive services, and medical equipment. However, it's important to note that certain services like additional hospital days, some dental procedures, and specific rehabilitation services may not be covered.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a $350 copay per admission or stay for Medicare-covered stays. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days for Inpatient Hospital Psychiatric 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 services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $175 copay, ambulatory surgical center services have a $125 copay, and individual and group sessions for outpatient substance abuse have a copay between $30-$30.
Partial Hospitalization See details
Partial Hospitalization is covered under the Freedom Blue PPO Select (PPO) plan. The specific costs for this benefit are not listed.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Freedom Blue PPO Select (PPO). Ground and air ambulance services have a $215 copay, while transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year. Transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, Urgently Needed Services have a $5 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $5 copay, and Worldwide Emergency Transportation has a $215 copay.
Primary Care See details
The Freedom Blue PPO Select (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $30 copay, mental health specialty services with a $30 copay for individual and group sessions, podiatry services with a $30 copay, other health care professional services with a copay between $0 and $30, psychiatric services with a $30 copay for individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a copay between $0 and $30, and opioid treatment program services with a $30 copay. Routine chiropractic care is limited to 8 visits per year.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, and additional preventive services. Additional preventive services include services like home and bathroom safety devices and modifications with 20% coinsurance, and remote access technologies with a copay between $0 and $30. However, services such as health education, counseling services, and others are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $30 copay, and prescription hearing aids with a $599-$899 copay, up to a maximum 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 include eye exams with a $30 copay, and eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum plan benefit of $425 every year. Routine eye exams are covered once per year.
Dental Services See details
Dental Services include Medicare Dental Services with a $30 copay, and Other Dental Services with a $15 copay. Oral exams, dental x-rays, and cleanings are covered, and fluoride treatment is not covered. Orthodontic services are covered, but 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
The Freedom Blue PPO Select (PPO) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Select (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered by the Freedom Blue PPO Select (PPO) plan, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies also have a 20% coinsurance, while 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, with a minimum copay of $0 for Diagnostic Procedures/Tests and Lab Services, and a minimum copay of $125 for Diagnostic Radiological Services, $60 for Therapeutic Radiological Services, and $20 for Outpatient X-Ray Services. If multiple services are received at the same location on the same day, only the maximum copay applies.
Home Health Services See details
Home Health Services are covered by the Freedom Blue PPO Select (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 none of the sub-services are covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Freedom Blue PPO Select (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Freedom Blue PPO Select (PPO) plan's Other Services benefit covers meal benefits for a chronic illness, but 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.
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