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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 $11.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. 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.
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 a $0 deductible for prescription drugs. During the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. Preferred Generic drugs have no copay at preferred pharmacies, but a $15 copay at standard pharmacies. The plan has a coinsurance of 25% for Standard Generic drugs, and 50% for Preferred Brand drugs. For Non-Preferred drugs, the coinsurance is 33%. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs.
Additional Benefits
The Freedom Blue PPO Distinct (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. For example, inpatient hospital stays have a copay of $375, and outpatient services have copays that vary. The plan also covers primary care, preventive services with no copay for annual physical exams, and vision and dental services with copays. Additional benefits include coverage for ambulance services, emergency services, hearing exams with a $20 copay, and prescription hearing aids with a copay between $699 and $999. Medical equipment, home health services, and skilled nursing facilities are covered, with some services having a copay or coinsurance. The plan also provides an over-the-counter (OTC) benefit with a maximum of $95 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, there is a $375 copay for a Medicare-covered stay, and Additional Days for Inpatient Hospital-Acute has no copay. For Inpatient Hospital Psychiatric, there is a $425 copay for days 1-3, and no copay for days 4-90.
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 (ASC) 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.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Freedom Blue PPO Distinct (PPO) plan. Ground and air ambulance services have a copay of $270.00, with no coinsurance, and transportation services to a plan-approved health-related location are covered, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage have a copay of $125, $35, $125, and $35, respectively, with no coinsurance. Worldwide Emergency Transportation has a $270 copay and 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 for routine foot care, 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 annual physical exams, with no copay. Additional preventive services are covered, but some services like health education, in-home safety assessments, and counseling services are not covered. Remote access technologies have a copay between $0 and $20, and home and bathroom safety devices have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered under the Freedom Blue PPO Distinct (PPO) plan, with a $20 copay for Routine Hearing Exams. Prescription Hearing Aids are covered, with a maximum plan benefit of $500 per year, and a copay between $699 and $999 for Prescription Hearing Aids (all types). 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 eye exams with a $20 copay. Eyewear is covered, with a combined maximum of $350 per year for both in-network and out-of-network services, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $20 copay, Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, Restorative Services with 10% coinsurance, Adjunctive General Services with 0-10% coinsurance, Endodontics, Periodontics, Prosthodontics (removable), Prosthodontics (fixed), and Oral and Maxillofacial Surgery with 10% coinsurance. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. The plan has a $2,500 maximum benefit per year.
Home Infusion bundled Services See details
The Freedom Blue PPO Distinct (PPO) plan covers home infusion bundled services, including Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%, as well as 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 Distinct (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered, with no copay. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies have a 20% coinsurance. Diabetic supplies have a 0-20% coinsurance, and diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Freedom Blue PPO Distinct (PPO) plan. Diagnostic procedures and tests, as well as 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 or coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but in practice, none of the sub-services are covered. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
The Freedom Blue PPO Distinct (PPO) plan covers Skilled Nursing Facility (SNF) services with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items and a meal benefit, but acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered. The OTC benefit has a maximum coverage amount of $95 every three months.
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