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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 Southeast 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 $60.00. 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 provides coverage for a variety of services, including inpatient hospital stays with a copay, outpatient services, and ambulance services. It also includes coverage for primary care, preventive services with no copay for Medicare-covered services, and vision and dental services with copays. This plan offers additional benefits such as hearing services with a copay, home infusion, dialysis, medical equipment, and diagnostic services. Other notable features include home health services with no copay, cardiac rehabilitation, and skilled nursing facility care with a copay after the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, there is a $300 copay per admission or stay, and additional days are covered with no copay. For Inpatient Hospital Psychiatric, there is a $325 copay for days 1-3, and no copay for days 4-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services and observation services with a $250 copay, Ambulatory Surgical Center (ASC) Services with a $200 copay, and outpatient substance abuse services with a $5 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Freedom Blue PPO Valor (PPO) plan. There is no information about the cost of services for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a $250 copay. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year using various modes of transportation, 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. Emergency Services has a $125 copay, while Urgently Needed Services has a $40 copay, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage, a $40 copay for Worldwide Urgent Coverage, and a $250 copay for Worldwide Emergency Transportation.
Primary Care See details
The Freedom Blue PPO Valor (PPO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $15 copay, while physician specialist services have a $10 copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services with no copay, annual physical exams, additional preventive services, kidney disease education services, and other preventive services. Some services, such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and counseling services are not covered. Remote access technologies have a copay of $0-$10, and home and bathroom safety devices and modifications have a 20% coinsurance.
Hearing Services See details
Hearing Services include routine hearing exams with a $10 copay, and are limited to 1 visit per year, as well as coverage for prescription hearing aids, which have a maximum benefit of $500 per year and a copay between $699 and $999. Fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $10 copay, and coverage for eyewear with a combined maximum benefit of $400 per year, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are covered once per year.
Dental Services See details
The Freedom Blue PPO Valor (PPO) plan covers Medicare dental services with a $10 copay, as well as other dental services with a $3,000 maximum benefit per year. Oral exams, dental x-rays, cleaning, and fluoride treatments are covered but limited to a certain number of visits, and certain services like maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs with a $35 copay, and Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs, with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Freedom Blue PPO Valor (PPO) plan. You are responsible for 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits under the Freedom Blue PPO Valor (PPO) plan include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetic Devices with a coinsurance between 20% and 20%, and Medical Supplies with 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20% and Diabetic Therapeutic Shoes/Inserts have a coinsurance between 20% and 20%. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered, and include coverage for all diagnostic and radiological services, with prior authorization required. Diagnostic procedures/tests and lab services are not covered. 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 covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is no copay or coinsurance for the covered services.
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 per day.
Other Services See details
The Freedom Blue PPO Valor (PPO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $100 every three months, but it does not cover acupuncture, meal benefits, 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, or self-directed personal assistance services.
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