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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 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 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 $65.00. 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) Medicare plan features a $0 drug deductible, allowing your prescription coverage to begin immediately. For Tier 1 preferred generic drugs, you pay no copay for a 1-month supply at a preferred pharmacy or a 3-month supply through preferred mail order. Tier 2 generic medications are also highly affordable, costing a $13 copay for a 1-month supply at preferred pharmacies compared to $19 at standard pharmacies. Tier 3 preferred brand drugs require a $45 copay for a 1-month supply at preferred pharmacies, while a 3-month supply through preferred mail order costs $115. For higher-tier medications, Tier 4 non-preferred drugs carry a 35% coinsurance, and Tier 5 specialty drugs require a 33% coinsurance. Utilizing preferred pharmacies and mail-order services provides the lowest out-of-pocket costs under this plan.
Additional Benefits
The Freedom Blue PPO ValueRx (PPO) plan offers comprehensive coverage with many essential healthcare services available at no cost to you. You will pay no copay or coinsurance for primary care doctor visits, routine preventive care, home health services, and laboratory tests. Additionally, the plan features no copay for eyewear up to a $425 annual limit, as well as up to 24 free one-way transportation trips per year to plan-approved locations. For other medical needs, predictable copays apply, such as a $40 copay for specialist visits, routine eye exams, and hearing exams. Inpatient hospital stays require a $220 daily copay for the first five days, after which there is no copay, while skilled nursing facility stays are covered with no copay for the first 20 days. Major medical equipment, diabetic supplies, and dialysis services generally require a 20% coinsurance with no copays.
Inpatient Hospital See details
Freedom Blue PPO ValueRx (PPO) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring prior authorization and a $220 daily copay for days 1 through 5, with no copay for days 6 through 90. The benefit is partially covered, as non-Medicare-covered stays, upgrades, and additional psychiatric days 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 covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Freedom Blue PPO ValueRx (PPO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Freedom Blue PPO ValueRx (PPO) covers ambulance services with a $320 copay and no coinsurance for both ground and air transport. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or 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 and no coinsurance, with the copay waived if you are admitted to the hospital within three days. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $50 to $320.
Primary Care See details
Freedom Blue PPO ValueRx (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, psychiatric, therapy, and podiatry services generally require a $40 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance for routine care, though other chiropractic services are not covered, and telehealth benefits are available with a $0 to $50 copay and no coinsurance.
Preventive Services See details
Freedom Blue PPO ValueRx (PPO) provides preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered, featuring memory fitness, remote access technologies with a $0 to $40 copay, and home safety devices with 20% coinsurance, while services like health education, personal emergency response systems, and in-home safety assessments are not covered.
Hearing Services See details
Freedom Blue PPO ValueRx (PPO) offers partial coverage for hearing services, featuring annual routine hearing exams with a $40 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, OTC hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Freedom Blue PPO ValueRx (PPO) covers vision services, with eye exams being partially covered at a $40 copay and no coinsurance for one routine yearly exam, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing a combined annual maximum benefit of $425 for contacts, lenses, frames, and upgrades.
Dental Services See details
Freedom Blue PPO ValueRx (PPO) offers partially covered dental services, with Medicare-covered dental requiring a $40 copay and no coinsurance, and other covered dental services requiring a $15 copay and no coinsurance. While oral exams, cleanings, and X-rays are covered with no coinsurance, this plan does not cover fluoride, restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, or orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered under Freedom Blue PPO ValueRx (PPO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance up to 20%, with insulin also requiring a $35 copay.
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, prosthetics, and diabetic equipment, 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 ValueRx (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Diagnostic tests have a copay of $0 to $20 with no copay for lab services, while radiological services require a $20 copay for X-rays, a minimum $60 copay for therapeutic services, and a minimum $200 copay for diagnostic radiology.
Home Health Services See details
Freedom Blue PPO ValueRx (PPO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these benefits.
Cardiac Rehabilitation Services See details
Freedom Blue PPO ValueRx (PPO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Freedom Blue PPO ValueRx (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. Patients pay no copay for days 1 through 20, and a $218 daily copay for days 21 through 100, with additional days beyond the Medicare-covered limit 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 additional services are not covered.
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