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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 West Central 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 $96.00. 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at a preferred pharmacy, or for a 3-month supply through preferred mail order. Tier 2 generic medications cost as low as a $13 copay for a 1-month supply at preferred pharmacies, while standard pharmacies charge a $19 copay. Brand-name and specialty medications under this plan have varying costs depending on the tier and pharmacy selection. Tier 3 preferred brand drugs require a $45 copay at preferred pharmacies, whereas Tier 4 non-preferred drugs have a $95 copay for a 1-month supply at preferred locations. Specialty tier drugs in Tier 5 require a 33% coinsurance for a 1-month supply at both standard and preferred pharmacies.
Additional Benefits
The Freedom Blue PPO Select (PPO) plan offers affordable medical coverage with no copay and no coinsurance for primary care visits, preventive screenings, and home health care. For specialized care, members pay a $30 copay for specialist visits and a $175 copay for outpatient hospital services, with no coinsurance. Inpatient hospital stays require a $350 copay per admission, while emergency room visits carry a $130 copay, both with no coinsurance. Routine dental, vision, and hearing services are partially covered, featuring low copays of $15 to $30 for exams and cleanings, alongside no-copay eyewear benefits and covered hearing aids. Diagnostic lab tests and home infusion services are available with no copay, while dialysis and durable medical equipment generally carry a 20% coinsurance. Additionally, the plan covers up to 24 one-way routine transportation trips and offers skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
Freedom Blue PPO Select (PPO) covers inpatient acute and psychiatric hospital stays with a $350 copay per admission and no coinsurance, though prior authorization is required. Unlimited additional days are covered for acute stays with no copay, but psychiatric additional days, room upgrades, and non-Medicare-covered stays 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, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Freedom Blue PPO Select (PPO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Freedom Blue PPO Select (PPO) covers ground and air ambulance services with a $350 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 Select (PPO) covers emergency services with a $130 copay (waived if admitted to the hospital within 3 days) and urgent care with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $50, and $350 respectively.
Primary Care See details
Freedom Blue PPO Select (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $30 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, excluding other non-routine chiropractic services, and telehealth benefits are available with a $0 to $50 copay and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by Freedom Blue PPO Select (PPO), offering no copay and no coinsurance for annual physical exams, kidney disease education, and routine screenings, while remote access technologies require a $0 to $30 copay and home safety devices require 20% coinsurance. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional tobacco cessation counseling, telemonitoring, and counseling.
Hearing Services See details
Hearing services are partially covered by Freedom Blue PPO Select (PPO), which features a $30 copay and no coinsurance for one routine hearing exam per year. Prescription hearing aids are covered with no coinsurance and a copay ranging from $599 to $899 up to a $500 annual limit, but fitting/evaluation, OTC hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Freedom Blue PPO Select (PPO), offering one routine eye exam per year for a $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear, including contacts, lenses, frames, and upgrades, is covered with no copay and no coinsurance up to a $425 combined annual maximum.
Dental Services See details
Freedom Blue PPO Select (PPO) partially covers dental services, featuring a $30.00 copay and no coinsurance for Medicare-covered dental, and a $15.00 copay and no coinsurance for other dental services such as cleanings, exams, and x-rays. Adjunctive general services are covered with no copay and no coinsurance, but fluoride, diagnostic, preventive, restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Freedom Blue PPO Select (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs range from no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under Freedom Blue PPO Select (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Freedom Blue PPO Select (PPO) with no copays for durable medical equipment, prosthetics, medical supplies, and diabetic equipment, though prior authorization is required. These benefits generally carry a 20% coinsurance, except for diabetic supplies which range from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Freedom Blue PPO Select (PPO) with no coinsurance, though prior authorization is required. Lab services require no copay, diagnostic tests range from no copay up to $15, outpatient X-rays carry a $20 copay, and diagnostic and therapeutic radiology services have minimum copays of $125 and $60, respectively.
Home Health Services See details
Home Health Services are covered by Freedom Blue PPO Select (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Freedom Blue PPO Select (PPO) does not cover Cardiac Rehabilitation Services. This includes cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services, which are all excluded from coverage under this plan.
Skilled Nursing Facility (SNF) See details
Freedom Blue PPO Select (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and a $218 copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Freedom Blue PPO Select (PPO), which features a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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