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Freedom Blue PPO Valor (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Valor (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 Valor (PPO) in 2025, please refer to our full plan details page.
Freedom Blue PPO Valor (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2025 to people living in WPA. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Freedom Blue PPO Valor (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Freedom Blue PPO Valor (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 Valor (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $75.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Freedom Blue PPO Valor (PPO).
Additional Benefits
The Freedom Blue PPO Valor (PPO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays for different services. You can expect a $275 copay for inpatient hospital stays and a $245 copay for outpatient services. The plan also provides coverage for ambulance services, emergency services, and primary care physician visits with copays ranging from $5-$125 depending on the service. Additional benefits include coverage for preventive, hearing, vision, and dental services. The plan covers hearing exams and offers coverage for prescription hearing aids with copays ranging from $699-$999. Vision services include eye exams with a $10 copay and eyewear coverage, and dental services have a $10 copay for Medicare dental services with a $3,000 annual maximum.
Inpatient Hospital See details
Inpatient Hospital benefits with the Freedom Blue PPO Valor (PPO) plan include coverage for Inpatient Hospital-Acute with a $275 copay per admission, and Additional Days for Inpatient Hospital-Acute with no copay. Inpatient Hospital Psychiatric has a $325 copay for days 1-3, and no copay for days 4-90. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including hospital services and observation services, have a copay of $245.00. Ambulatory Surgical Center (ASC) services have a copay of $195.00, and outpatient substance abuse services have a copay of $5.00 per session. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the Freedom Blue PPO Valor (PPO) plan. The plan covers the services, but does not include any cost information.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Freedom Blue PPO Valor (PPO) plan, with a $250 copay for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Freedom Blue PPO Valor (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $50 copay, both with no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $250 copay, all with no coinsurance.
Primary Care See details
The Freedom Blue PPO Valor (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $15 copay, physician specialist services with a $10 copay, mental health specialty services with a $5 copay, podiatry services with a $10 copay, other health care professional services with a copay between $0 and $10, psychiatric services with a $5 copay, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a copay between $0 and $50, and opioid treatment program services with a $5 copay. Routine foot care is covered for up to 10 visits per year with a $10 copay, and individual and group sessions for mental health and psychiatric services have a $5 copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams, and additional services. Additional preventive services may have coinsurance of 20% for home and bathroom safety devices and modifications, and copays of $0-$10 for remote access technologies.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $10 copay, and prescription hearing aids with a $699-$999 copay, up to a maximum benefit of $500 per year. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a $10 copay, and eyewear with a combined maximum benefit of $400 per year for in-network 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 are covered, with a $10 copay for Medicare Dental Services. Other dental services have a maximum plan benefit of $3,000 per year and include Oral Exams with a limit of one every six months, Dental X-Rays with a limit of one per year, Prophylaxis (Cleaning) and Fluoride Treatment with a limit of one every six months, plus Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, Prosthodontics, fixed and Oral and Maxillofacial Surgery. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not 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 the coinsurance ranges from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Valor (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment is covered by the Freedom Blue PPO Valor (PPO) plan, with Durable Medical Equipment (DME) requiring a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 0-20% coinsurance depending on the specific supply.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Freedom Blue PPO Valor (PPO) plan. Diagnostic services, including procedures/tests and lab services, are not covered, while diagnostic radiological services have a copay of at most $225, therapeutic radiological services have a copay of at most $60, and outpatient X-ray services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Freedom Blue PPO Valor (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Freedom Blue PPO Valor (PPO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Freedom Blue PPO Valor (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services for the Freedom Blue PPO Valor (PPO) plan includes Over-the-Counter (OTC) Items with a maximum benefit of $100 every three months. Acupuncture, Meal Benefit, 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 are not covered.
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