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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 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 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 $79.00. 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 features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at a preferred pharmacy, while standard pharmacies charge a $5 copay for a 1-month supply. Tier 2 generic medications cost a $13 copay for a 1-month supply at preferred pharmacies and $19 at standard pharmacies. Tier 3 preferred brand drugs require a $45 copay for a 1-month supply at preferred pharmacies, with mail-order options offering potential savings. Higher-tier medications carry coinsurance rather than flat copays, with Tier 4 non-preferred drugs requiring 35% coinsurance and Tier 5 specialty drugs requiring 33% coinsurance. Choosing preferred pharmacies and mail-order services under this plan helps maximize your savings on prescription drug costs.
Additional Benefits
The Freedom Blue PPO ValueRx (PPO) plan offers robust coverage for essential medical services, focusing on low out-of-pocket costs with no coinsurance for many key benefits. Members enjoy no copay for primary care visits, home health services, and preventive care, while specialist visits and routine dental exams require a low copay. Emergency services are covered with a $130 copay, and inpatient hospital stays require a $220 daily copay for the first five days, followed by no copay for days six through ninety. This plan also includes valuable supplemental benefits, such as up to 24 one-way transportation trips to plan-approved locations with no copay. Vision care features a $425 annual allowance for eyewear with no copay, while routine hearing exams require a $40 copay. Durable medical equipment and dialysis services are covered with no copay and a standard 20% coinsurance.
Inpatient Hospital See details
Freedom Blue PPO ValueRx (PPO) offers partially covered inpatient hospital services with no coinsurance, requiring a copay of $220 per day for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Freedom Blue PPO ValueRx (PPO) covers outpatient hospital and observation services with a $200 copay and no coinsurance, and ambulatory surgical center services with a $175 copay and no coinsurance. Outpatient substance abuse sessions require a $40 copay and no coinsurance, while outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Freedom Blue PPO ValueRx (PPO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Freedom Blue PPO ValueRx (PPO) covers emergency ground and air ambulance services with a $275 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Freedom Blue PPO ValueRx (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 3 days, and urgently needed services 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 $275, respectively.
Primary Care See details
Freedom Blue PPO ValueRx (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $40 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance for routine care up to six visits per year, though other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Freedom Blue PPO ValueRx (PPO), offering annual physical exams, kidney disease education, and other screenings with no copay and no coinsurance. Covered supplemental benefits include memory fitness, remote access technologies (with a $0 to $40 copay and no coinsurance), and home safety devices (with a 20% coinsurance and no copay). However, health education, PERS, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, telemonitoring, counseling, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Freedom Blue PPO ValueRx (PPO) partially covers hearing services, offering one routine hearing exam per year with a $40 copay, no deductible, and no coinsurance, though fitting and evaluation exams are not covered. Prescription hearing aids are covered up to a $500 annual maximum with copays ranging from $599 to $899 and no coinsurance, but OTC hearing aids and inner, outer, or over the ear prescription devices are not covered.
Vision Services See details
Freedom Blue PPO ValueRx (PPO) provides partially covered vision services with no deductibles, offering one routine eye exam per year for a $40 copay and no coinsurance, though other eye exam services are not covered. Eyewear is fully covered with no copay and no coinsurance, providing up to a $425 combined annual maximum benefit for contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Freedom Blue PPO ValueRx (PPO) provides partially covered dental services, featuring a $40 copay and no coinsurance for Medicare-covered dental, and a $15 copay with no coinsurance for covered preventive care like exams, cleanings, and x-rays. Several major services are not covered, including fluoride, restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Freedom Blue PPO ValueRx (PPO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy may be required. Part B chemotherapy, radiation, and other drugs are covered with no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Freedom Blue PPO ValueRx (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Freedom Blue PPO ValueRx (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic equipment, with no copays and generally a 20% coinsurance. Diabetic supplies feature a 0% to 20% coinsurance from specified manufacturers, and prior authorization is required for these covered services.
Diagnostic and Radiological Services See details
Freedom Blue PPO ValueRx (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. There is no copay for lab services, a $0 to $20 copay for diagnostic tests, a $20 copay for X-rays, a $60 copay for therapeutic radiology, and a $200 copay for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the Freedom Blue PPO ValueRx (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Freedom Blue PPO ValueRx (PPO) covers some services under Cardiac Rehabilitation Services with no copay and no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Freedom Blue PPO ValueRx (PPO) with no coinsurance, requiring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100 per admission. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Freedom Blue PPO ValueRx (PPO) partially covers other services, offering a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and other supplemental services are not covered under this plan.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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