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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 West Central 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 $42.00. 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 a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for each prescription, depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $13 copay at preferred pharmacies, while standard generic drugs have a $45 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, your premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Freedom Blue PPO ValueRx (PPO) plan offers a variety of benefits, including inpatient and outpatient hospital care, with varying copays. The plan covers primary care, specialist visits, and mental health services, with copays ranging from $15 to $40. Additionally, it includes coverage for vision, hearing, and dental services, with specific copays and limitations for each. This plan provides coverage for ambulance services, emergency services, and home health services, with some services requiring copays or coinsurance. The plan also offers some additional benefits like home infusion, dialysis, and medical equipment. However, certain services like cardiac rehabilitation, acupuncture, and over-the-counter items are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a $220 copay for days 1-5, and no copay for days 6-90. Additional days for inpatient hospital-acute are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a $200 copay, observation services with a $200 copay, and ambulatory surgical center services with a $175 copay. Outpatient substance abuse individual and group sessions have a copay between $40 and $40. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the Freedom Blue PPO ValueRx (PPO) plan. There is no additional information about the cost of this benefit in the provided snippet.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $260 copay for both ground and air ambulance services. Transportation Services to any health-related location are not covered, but the plan covers 24 one-way trips per year to plan-approved health-related locations.
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 has a $125 copay and no coinsurance, Urgently Needed Services has a $5 copay and no coinsurance, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $5 copay, and Worldwide Emergency Transportation has a $260 copay, and all have no coinsurance.
Primary Care See details
The Freedom Blue PPO ValueRx (PPO) plan covers primary care physician services, chiropractic services (with a $15 copay), occupational therapy services (with a $40 copay), physician specialist services (with a $40 copay), mental health specialty services (with a $40 copay for individual and group sessions), podiatry services (with a $40 copay for Medicare-covered services and routine foot care), other health care professional services (with a copay between $0 and $40), psychiatric services (with a $40 copay for individual and group sessions), physical therapy and speech-language pathology services (with a $40 copay), additional telehealth benefits (with a copay between $0 and $40), and opioid treatment program services (with a $40 copay). Routine chiropractic care is limited to 6 visits per year, and routine foot care is limited to 8 visits per year.
Preventive Services See details
The Freedom Blue PPO ValueRx (PPO) plan covers preventive services, including Medicare-covered services with no copay. Additional preventive services have a copay and coinsurance, while health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, telemonitoring services, and counseling services are not covered. The plan also covers remote access technologies with a copay between $0 and $40, home and bathroom safety devices with 20% coinsurance, and fitness benefits.
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, but fitting/evaluation for hearing aids, and OTC hearing aids are not covered. You are allowed one routine hearing exam every year.
Vision Services See details
The Freedom Blue PPO ValueRx (PPO) plan covers vision services, including eye exams with a $40 copay. Eyewear benefits are covered, with a combined maximum benefit of $425 every year for both in and out-of-network services. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a $40 copay, and Other Dental Services with a $15 copay. Oral exams, dental x-rays, prophylaxis (cleaning) and adjunctive general services are covered, while fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
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 include Durable Medical Equipment (DME) with 20% coinsurance and prior authorization required, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with a coinsurance that varies by service and prior authorization required. Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have between 0% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
The Freedom Blue PPO ValueRx (PPO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $20, Lab Services have no copay, Diagnostic Radiological Services have a copay of $200, Therapeutic Radiological Services have a copay of $60, and Outpatient X-Ray Services have a copay of $20.
Home Health Services See details
Home Health Services are covered by the Freedom Blue PPO ValueRx (PPO) plan with no copay and no coinsurance, but authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not in practice, as Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF 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 offers a meal benefit for chronic illnesses, but does not have a maximum coverage amount.
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