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Freedom Blue PPO Distinct (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Distinct (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 Distinct (PPO) in 2025, please refer to our full plan details page.
Freedom Blue PPO Distinct (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2025 to people living in Region 2 WV 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 Distinct (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 Distinct (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 Distinct (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $14.00. 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 $9550.00 (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 $9550.00 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 Distinct (PPO) plan has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. In the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies, but a $15 copay at standard pharmacies. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Freedom Blue PPO Distinct (PPO) plan offers a range of benefits with varying costs. Hospital stays have a copay, with inpatient acute care at $375 and psychiatric care at $425 for the initial days. Outpatient services have copays, such as $300 for hospital services and $40 for substance abuse sessions. Emergency services have a $125 copay, and primary care visits range from no copay to $40. Preventive services have no copay, while vision services include eye exams for a $20 copay and eyewear up to a $350 annual limit. Dental services have a $20 copay for Medicare-covered services and other dental services up to a $2,500 annual maximum, with coinsurance for some procedures. Home health services have no copay, but some services like cardiac rehabilitation are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization. Inpatient Hospital-Acute has a $375 copay for Medicare-covered stays, and additional days have no copay; Inpatient Hospital Psychiatric has a $425 copay for days 1-3, and no copay for days 4-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $300 copay, observation services with a $300 copay, ambulatory surgical center services with a $225 copay, and outpatient substance abuse services with a $40 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 Distinct (PPO) plan. There is no additional information provided about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Freedom Blue PPO Distinct (PPO) plan, with prior authorization required. Ground and air ambulance services each have a copay of $270, with no coinsurance. Transportation Services to a plan-approved health-related location are covered, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Freedom Blue PPO Distinct (PPO) plan. Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a $35 copay and no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $35 copay, and Worldwide Emergency Transportation has a $270 copay; all have no coinsurance.
Primary Care See details
The Freedom Blue PPO Distinct (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $25 copay, physician specialist services with a $20 copay, mental health specialty services with a $40 copay for individual and group sessions, podiatry services with a $20 copay, other health care professional services with a copay between $0 and $20, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $40 copay. Routine chiropractic care is limited to 8 visits per year.
Preventive Services See details
The Freedom Blue PPO Distinct (PPO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, and other preventive services. The plan also covers Remote Access Technologies with a copay between $0-$20, and Home and Bathroom Safety Devices and Modifications with 20% coinsurance. Some services, such as Health Education and Counseling Services, are not covered.
Hearing Services See details
Hearing exams are covered with a $20 copay, and routine hearing exams are covered with a copay between $25 and $25. Prescription hearing aids are covered with a copay between $699 and $999, and a maximum benefit of $500 per year. Fitting/evaluation for hearing aids, prescription hearing aids (inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $20 copay, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum plan benefit coverage of $350 every year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $20 copay, and other dental services with a $2,500 annual maximum. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with 10% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits under the Freedom Blue PPO Distinct (PPO) plan cover Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Freedom Blue PPO Distinct (PPO) plan. Diagnostic procedures/tests and lab services are not covered, while Diagnostic Radiological Services have a copay of at most $200, Therapeutic Radiological Services have a copay of at most $60, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Freedom Blue PPO Distinct (PPO) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. This means that this benefit is not covered by the plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the Freedom Blue PPO Distinct (PPO) plan, requiring prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $75 every three months, and Meal Benefits for a chronic illness, but does not cover Acupuncture, Dual Eligible SNPs with Highly Integrated Services, or a variety of other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services.
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