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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 2026, 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 2026.
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) Medicare plan offers a $0 prescription drug deductible, allowing your coverage to begin 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 3-month preferred mail orders. Tier 2 generic prescriptions are also budget-friendly, starting at a $13 copay for a 1-month supply when using a preferred pharmacy. For brand-name and specialty medications, the plan utilizes a tiered copay and coinsurance system to determine your costs. Tier 3 preferred brand drugs start at a $45 copay for a 1-month supply, while Tier 4 non-preferred drugs start at a $95 copay at preferred pharmacies. High-cost Tier 5 specialty drugs require a 33% coinsurance for a 1-month supply at both standard and preferred pharmacies or mail-order services.
Additional Benefits
The Freedom Blue PPO Select (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care visits, preventive screenings, and home health services. For more specialized care, members pay a $30 copay for specialist visits and a $175 copay for outpatient hospital services with no coinsurance. Emergency care is available with a $130 copay, which is waived upon hospital admission, while inpatient hospital stays require a $350 copay per stay. This plan also includes essential routine benefits, featuring no copay for preventive dental services and up to $425 annually for eyewear with no copay. Routine vision and hearing exams are accessible with a $30 copay, while medical equipment and dialysis services are covered with no copay and a 20% coinsurance. Skilled nursing facility stays are covered with no copay for the first 20 days, followed by a daily copay of $218 for days 21 through 100.
Inpatient Hospital See details
Freedom Blue PPO Select (PPO) covers inpatient acute and psychiatric hospital services with a $350 copay per stay and no coinsurance, though prior authorization is required. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Freedom Blue PPO Select (PPO) covers outpatient services with no coinsurance, featuring a $175 copay for outpatient hospital services and daily observation services, and a $125 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $30 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Freedom Blue PPO Select (PPO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Freedom Blue PPO Select (PPO), featuring a $300 copay and no coinsurance for both ground and air ambulance services. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Freedom Blue PPO Select (PPO) with a $130 copay and no coinsurance, and this copay is waived if you are admitted to the hospital within three days. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency services feature no coinsurance and copays of $50 for urgent care, $130 for emergency care, and $300 for emergency transportation.
Primary Care See details
Freedom Blue PPO Select (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, therapy, and mental health services require a $30 copay and no coinsurance. Chiropractic benefits are partially covered with a $15 copay and no coinsurance for up to 8 routine visits per year, though other chiropractic services are not covered.
Preventive Services See details
Freedom Blue PPO Select (PPO) covers preventive services, including annual physical exams, kidney disease education, and other screenings with no copay and no coinsurance. Additional preventive benefits are partially covered, including memory fitness, disease management, remote access technologies ($0 to $30 copay), and home safety devices (20% coinsurance), while health education, PERS, medical nutrition therapy, counseling, alternative therapies, in-home safety assessments, medication reconciliation, re-admission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, and telemonitoring are not covered.
Hearing Services See details
Freedom Blue PPO Select (PPO) partially covers hearing services, providing annual routine hearing exams for a $30 copay and no coinsurance, and prescription hearing aids with a $599 to $899 copay and no coinsurance up to a $500 annual maximum. Fitting and evaluation services, over-the-counter hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Freedom Blue PPO Select (PPO) vision services cover one routine eye exam annually with a $30 copay and no coinsurance, although other eye exam services are not covered. Eyewear, including contacts, frames, lenses, and upgrades, is covered with no copay and no coinsurance up to a combined maximum benefit of $425 per year.
Dental Services See details
Freedom Blue PPO Select (PPO) offers partially covered dental services, featuring Medicare-covered dental services for a $30 copay and no coinsurance, and other dental services for a $15 copay and no coinsurance. While preventive services like oral exams, cleanings, and X-rays are covered with no coinsurance, other diagnostic services, fluoride, restorative care, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Freedom Blue PPO Select (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no copay and range from no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Freedom Blue PPO Select (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Freedom Blue PPO Select (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic services, with no copays 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 Select (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic procedures range from a $0 to $15 copay, outpatient X-rays carry a $20 copay, and diagnostic and therapeutic radiological services require minimum copays of $125 and $60, respectively.
Home Health Services See details
Home Health Services are covered under the Freedom Blue PPO Select (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Freedom Blue PPO Select (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 Select (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a daily copay of $218 for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Freedom Blue PPO Select (PPO) partially covers other services, offering 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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