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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 Central and Northeastern 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 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 wide range of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the service. You'll also have access to primary care, preventive, hearing, vision, and dental services. This plan provides additional coverage for ambulance and transportation, emergency services, and home health services, with some services having copays and others having no copay. Other benefits include coverage for home infusion, dialysis, medical equipment, diagnostic and radiological services, and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. The copay for Inpatient Hospital-Acute is $275 per admission or stay, and the copay for Inpatient Hospital Psychiatric is $325 for days 1-3, and no copay for days 4-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $245 copay, ambulatory surgical center services have a $195 copay, and outpatient substance abuse services have a $5 copay for both individual and group sessions. Outpatient blood services include an enhanced benefit with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Freedom Blue PPO Valor (PPO) plan. This plan covers partial hospitalization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including Ground Ambulance Services and Air Ambulance Services, each with a $250 copay. Transportation Services to a plan-approved health-related location are also covered, with up to 24 one-way trips per year. 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 under the Freedom Blue PPO Valor (PPO) plan. Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a $50 copay and no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $250 copay.
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 with a $10 copay for up to 10 visits per year.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams, additional preventive services, kidney disease education services, and other preventive services like glaucoma screening and diabetes self-management training. Some services like health education, in-home safety assessments, and counseling services are not covered. Remote access technologies have a copay of $0-$10, and home and bathroom safety devices have a 20% coinsurance.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $10 copay, and prescription hearing aids with a copay between $699 and $999, up to a maximum of $500 per year for both in-network and out-of-network services. Fitting/evaluation for hearing aids, OTC hearing aids, and prescription hearing aids for the inner, outer, and over-the-ear 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 every year. Eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and contact lenses are also covered.
Dental Services See details
The Freedom Blue PPO Valor (PPO) plan covers Medicare Dental Services with a $10 copay. Other dental services are covered and include oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments.
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 between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Freedom Blue PPO Valor (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the Freedom Blue PPO Valor (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, while Medical Supplies have a 20% coinsurance. Diabetic Supplies have between 0% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Freedom Blue PPO Valor (PPO) plan. Diagnostic services, including diagnostic procedures and lab services, are not covered. For diagnostic radiological services, there is a copay of at most $225, while therapeutic radiological services have a maximum copay of $60. 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. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits 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, the copay is $214.
Other Services See details
Other Services includes coverage for over-the-counter (OTC) items, with a maximum benefit of $100 every three months, but acupuncture, meal benefits, dual eligible SNPs, EPSDT services, private duty nursing services, case management, 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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