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Freedom Blue PPO Signature (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Signature (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 Signature (PPO) in 2025, please refer to our full plan details page.
Freedom Blue PPO Signature (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 Signature (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 Signature (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 Signature (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 $3.00. 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 $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 Signature (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay a $5 copay at a preferred pharmacy and a $20 copay at a standard pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Freedom Blue PPO Signature (PPO) plan offers a range of benefits with varying costs. Hospital stays have a copay, with costs dependent on the type and length of stay. Outpatient services, including doctor visits, have copays, while preventive services are covered with no copay for many services, but some services are not covered. Additional benefits include coverage for ambulance, emergency, and vision services, with specific copays for each. Dental services are also covered, with a maximum annual benefit. Home health and skilled nursing facility services are covered with no copay for a certain number of days, but some services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $250 copay for days 1-3 and no copay for days 4-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric has a $425 copay for days 1-3 and no copay for days 4-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay 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 (ASC) Services with a $250 copay, and Outpatient Substance Abuse Services with a $40-$40 copay for individual and group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
The Freedom Blue PPO Signature (PPO) plan covers ambulance and transportation services. Ground and air ambulance services have a copay of $275, and there is no coinsurance. Transportation services to a plan-approved health-related location are covered, and 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 have a $110 copay, Urgently Needed Services have a $35 copay, Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $35 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The Freedom Blue PPO Signature (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy with a $30 copay, and physician specialist services with a $25 copay. Mental health specialty services have a $40 copay for individual and group sessions, podiatry services have a $25 copay, and other health care professionals have a copay between $0 and $25. The plan also covers psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $40 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, and additional preventive services, but does not cover Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Telemonitoring Services, and Counseling Services. The plan also covers Fitness Benefit, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) with a copay between $0 and $25, and Home and Bathroom Safety Devices and Modifications with 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, and prescription hearing aids with a copay between $699 and $999, up to a maximum of $500 per year. 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 $25 copay, as well as coverage for eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum plan benefit coverage of $350 per year.
Dental Services See details
The Freedom Blue PPO Signature (PPO) plan covers dental services, including Medicare dental services with a $25 copay. Other dental services are covered with a $2,000 maximum benefit per year, and include oral exams, dental x-rays, cleaning, and fluoride treatments, each limited to one visit every six months. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed) and oral and maxillofacial surgery are covered with 20% coinsurance, and services are limited. The plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Freedom Blue PPO Signature (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by the Freedom Blue PPO Signature (PPO) plan, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, and Diabetic Supplies with 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, are covered under this plan, with a copay for diagnostic procedures/tests ranging from $0 to $10 and no copay for lab services. Diagnostic Radiological Services have a maximum copay of $250, Therapeutic Radiological Services have a maximum copay of $60, and Outpatient X-Ray Services have a copay of $25.
Home Health Services See details
Home Health Services are covered by the Freedom Blue PPO Signature (PPO) plan, with no copay and no coinsurance, though authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered by the Freedom Blue PPO Signature (PPO) plan, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Freedom Blue PPO Signature (PPO) plan, but require 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 $150 every three months, but does not cover Acupuncture, Meal Benefit, 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.
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