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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 2026, 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 2026.
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 comprehensive medical coverage, featuring no copay for primary care physician visits and a $10 copay for specialist consultations. For urgent or emergency needs, emergency room visits carry a $130 copay, while inpatient hospital stays require a $275 copay per admission with no coinsurance. Outpatient hospital services and routine diagnostic lab tests are also highly affordable, requiring a $245 copay and no copay respectively. In addition to medical care, members benefit from dental coverage up to a $3,000 annual maximum with no copay for preventive services, and a $10 copay for routine vision and hearing exams. The plan also includes a $400 annual eyewear allowance, prescription hearing aid coverage, and a $100 over-the-counter benefit every three months with no copay. Finally, home health services and the first 20 days of skilled nursing facility care are covered with no copay or coinsurance.
Inpatient Hospital See details
Freedom Blue PPO Valor (PPO) covers inpatient acute hospital stays with a $275 copay per admission and no coinsurance, excluding upgrades and non-Medicare-covered stays. Inpatient psychiatric care is covered with no coinsurance, requiring a $325 daily copay for days 1 through 3 and no copay for days 4 through 90, though additional psychiatric days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Freedom Blue PPO Valor (PPO) covers outpatient hospital and daily observation services with a $245 copay and no coinsurance, and ambulatory surgical center services with a $195 copay and no coinsurance. Outpatient substance abuse sessions require a $5 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 Valor (PPO) with no copay and no coinsurance. This means you will face no out-of-pocket costs for covered partial hospitalization services under this plan.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Freedom Blue PPO Valor (PPO), with ground and air ambulance services requiring a $275 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Freedom Blue PPO Valor (PPO) covers emergency services with a $130.00 copay and no coinsurance, with the copay waived if admitted to the hospital within three days. Urgently needed services are covered with a $40.00 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130.00, $40.00, and $275.00 respectively.
Primary Care See details
Freedom Blue PPO Valor (PPO) primary care benefits feature no copay and no coinsurance for primary care visits, and a $10 copay with no coinsurance for specialist visits. Therapy, mental health, podiatry, and telehealth services range from a $0 to $15 copay with no coinsurance, though chiropractic care is only partially covered as other chiropractic services are not covered.
Preventive Services See details
Freedom Blue PPO Valor (PPO) covers annual exams, kidney disease education, and other preventive screenings with no copay and no coinsurance. Additional benefits are partially covered, including memory fitness, remote access technologies (with a $0 to $10 copay and no coinsurance), and home safety devices (with a 20% coinsurance and no copay). Sub-services such as health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy-related wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, and counseling are not covered.
Hearing Services See details
Freedom Blue PPO Valor (PPO) hearing services are partially covered, offering routine hearing exams for a $10 copay and no coinsurance, and prescription hearing aids with copays ranging from $699 to $999 and no coinsurance. However, OTC hearing aids, fitting and evaluation services, and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Freedom Blue PPO Valor (PPO), featuring one routine eye exam per year for a $10 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, including contacts and eyeglasses, has no copay and no coinsurance, subject to a $400 combined annual maximum.
Dental Services See details
Freedom Blue PPO Valor (PPO) partially covers dental services up to a $3,000 annual maximum, with a $10 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services. While preventive and restorative options like cleanings, exams, and root canals are covered, this plan does not cover other diagnostic services, other preventive services, maxillofacial prosthetics, implants, or orthodontics.
Home Infusion bundled Services See details
Freedom Blue PPO Valor (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under Freedom Blue PPO Valor (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Freedom Blue PPO Valor (PPO) with no copays, though prior authorization is required. Durable medical equipment requires no coinsurance to 50% coinsurance, diabetic supplies require no coinsurance to 20% coinsurance, and prosthetics, medical supplies, and diabetic shoes carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Freedom Blue PPO Valor (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic procedures range from a $0 to $10 copay, outpatient X-rays cost a $20 copay, and therapeutic and diagnostic radiological services require minimum copays of $60 and $225, respectively.
Home Health Services See details
Home Health Services are covered under the Freedom Blue PPO Valor (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Freedom Blue PPO Valor (PPO) covers some 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 partially covered by Freedom Blue PPO Valor (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Freedom Blue PPO Valor (PPO) partially covers other services, offering an over-the-counter (OTC) benefit with no copay and no coinsurance up to a maximum of $100 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this benefit.
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