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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 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 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 $45.00. 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 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 type. For example, preferred generic drugs have a $13 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy (LIS), your Part D premium is reduced. You should check the plan's formulary for specific drug coverage details.
Additional Benefits
The Freedom Blue PPO ValueRx (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, with no copay for days 6-90. Outpatient services, including hospital and substance abuse services, have copays. The plan covers emergency services, primary care, preventive services, and home health services with no copay. Hearing, vision, and dental services are covered, with copays for exams and specific services. Additional benefits include ambulance services, dialysis, home infusion, medical equipment, and skilled nursing facility stays, but some services may have coinsurance or require authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered. For days 1-5, there is a $220 copay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered, and Non-Medicare-covered Stay and Upgrades are not covered.
Outpatient Services See details
Outpatient Services for Freedom Blue PPO ValueRx (PPO) includes coverage for outpatient hospital services with a $200 copay, observation services with a $200 copay, ambulatory surgical center services with a $175 copay, and outpatient substance abuse services with a $40 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered. This plan offers coverage for partial hospitalization services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $260 copay, but no coinsurance. Transportation Services to any health-related location are covered with a limit of 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 under the Freedom Blue PPO ValueRx (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $5 copay, and Worldwide Emergency Transportation has a $260 copay; all services have no coinsurance.
Primary Care See details
The Freedom Blue PPO ValueRx (PPO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $15 copay, occupational therapy services, mental health specialty services, psychiatric services, podiatry services, and opioid treatment program services have a $40 copay, physician specialist services and physical therapy and speech-language pathology services have a $40 copay, and other health care professional services have a copay between $0 and $40.
Preventive Services See details
Preventive services, including Medicare-covered services and annual physical exams, are covered. Additional preventive services, such as remote access technologies, may have a copay of up to $40. Home and bathroom safety devices and modifications have a 20% coinsurance. Some services, including health education, counseling services, and several others, are not covered.
Hearing Services See details
Hearing Services include coverage for 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 aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, over the ear hearing aids, and OTC hearing aids are not covered. Routine hearing exams are limited to 1 visit per year.
Vision Services See details
The Freedom Blue PPO ValueRx (PPO) plan covers vision services, including eye exams with a $40 copay, and eyewear with a combined maximum benefit of $425 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services include Medicare dental services with a $40 copay, and other dental services with a $15 copay. Oral exams, dental X-rays, and prophylaxis (cleaning) are covered, but fluoride treatment is not covered. Orthodontic services are covered, while restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered. Adjunctive general services are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance may apply. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance may apply.
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 under the Freedom Blue PPO ValueRx (PPO) plan. Durable Medical Equipment has a 20% coinsurance, and requires authorization. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Equipment has varying coinsurance depending on the specific service.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay required for some services. Diagnostic Procedures/Tests have a copay between $0 and $20, Lab Services have no copay, Diagnostic Radiological Services have a $200 copay, Therapeutic Radiological Services have a $60 copay, and Outpatient X-Ray Services have a $20 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. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but some services are not 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 ValueRx (PPO) plan, with prior authorization required. There is no copay for days 1-20, and a $214 copay per day for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Freedom Blue PPO ValueRx (PPO) plan 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 for chronic illness, but does not have a maximum plan benefit coverage amount.
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