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Freedom Blue PPO Standard (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Standard (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 Standard (PPO) in 2025, please refer to our full plan details page.
Freedom Blue PPO Standard (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2025 to people living in West Virginia Region 1 counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Freedom Blue PPO Standard (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 Standard (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 Standard (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $134.00. 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 $10000.00 (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 $10000.00 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 Standard (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for each prescription, depending on the drug tier and pharmacy. For example, a preferred generic drug has an $11 copay at a preferred pharmacy, and a $19 copay at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The Freedom Blue PPO Standard (PPO) plan offers comprehensive coverage with a variety of services. This plan includes coverage for inpatient and outpatient services, primary care, preventive services, hearing, vision, and dental services. The plan also covers emergency services, ambulance, and transportation services. Additionally, it provides coverage for home health services, dialysis, and medical equipment. There are copays and coinsurance associated with many of these services, so be sure to review the details for each specific service.
Inpatient Hospital See details
The Freedom Blue PPO Standard (PPO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For the first 7 days, there is a $150 copay, and there is no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and outpatient substance abuse services, are covered. Outpatient hospital and observation services have a $150 copay, ambulatory surgical center services have a $100 copay, and individual and group outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Freedom Blue PPO Standard (PPO) plan. The plan covers the costs of partial hospitalization, but does not specify any cost-sharing details like copays or coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Freedom Blue PPO Standard (PPO) plan. Ground and air ambulance services have a copay of $225.00, with no coinsurance. Transportation Services to a plan-approved health-related location are covered for 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $5 copay, and Worldwide Emergency Transportation has a $225 copay. Worldwide Urgent Coverage has a $5 copay.
Primary Care See details
The Freedom Blue PPO Standard (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services, physician specialist services with a $35 copay, mental health specialty services with a $35 copay, podiatry services with a $35 copay, other health care professional services with a copay between $0 and $35, psychiatric services with a $35 copay, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $35, and opioid treatment program services with a $35 copay. Routine chiropractic care and routine foot care are limited to 8 and 10 visits per year, respectively.
Preventive Services See details
Preventive services, including Medicare-covered services and annual physical exams, are covered. Additional preventive services are covered, but some services like Health Education, Counseling Services, and several others are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $35 copay, and prescription hearing aids with a copay between $399 and $699, up to a maximum of $500 every year for both in-network and out-of-network services. Fitting/Evaluation for Hearing Aid, 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 coverage for eye exams with a $35 copay, and eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $425 every year. Routine eye exams are covered once per year.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $35 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, and Oral and Maxillofacial Surgery are not covered. Orthodontic Services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with coinsurance between 0% and 20%, and 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 under the Freedom Blue PPO Standard (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the Freedom Blue PPO Standard (PPO) plan, with a 20% coinsurance for Durable Medical Equipment (DME) and Prosthetic Devices, and a 0-20% coinsurance for Diabetic Supplies. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Freedom Blue PPO Standard (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $10, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $75, Therapeutic Radiological Services have a copay of at most $60, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Freedom Blue PPO Standard (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services are covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the Freedom Blue PPO Standard (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Other Services are not covered, including 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 does cover a Meal Benefit for chronic illnesses.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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