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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 $4.00. 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 example, preferred generic drugs have a $5 copay at preferred pharmacies and a $20 copay at standard pharmacies. Once your total drug costs reach $2,000, you enter the next phase where you pay nothing for covered drugs.
Additional Benefits
The Freedom Blue PPO Signature (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays, outpatient services, and various doctor visits. The plan has a deductible with varying copays for services like inpatient hospital stays, and emergency services. This plan also includes coverage for preventive services, hearing, vision, and dental care, with copays for exams and other services. Additionally, it covers ambulance services, home health services, and medical equipment, with some services requiring a copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits under the Freedom Blue PPO Signature (PPO) plan include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $250 copay for days 1-3, and no copay for days 4-90; for Inpatient Hospital Psychiatric, you will pay 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. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all 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 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 Signature (PPO) plan. There is no additional information about the cost of services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Freedom Blue PPO Signature (PPO) plan. Both ground and air ambulance services have a copay of $275, with no coinsurance. Transportation services to a plan-approved health-related location are covered, and 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 Signature (PPO) plan. 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
Freedom Blue PPO Signature (PPO) covers primary care physician services, chiropractic services with a $15 copay, occupational therapy with a $30 copay, specialist services with a $25 copay, mental health specialty services with a $40 copay for individual and group sessions, podiatry services with a $25 copay, other health care professionals with a $0-$25 copay, 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 $0-$40 copay, and opioid treatment program services with a $40 copay. Routine foot care is covered for up to 10 visits per year with a $25 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. Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) have a copay of $0-$25, and Home and Bathroom Safety Devices and Modifications have a 20% coinsurance. 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 are not covered.
Hearing Services See details
The Freedom Blue PPO Signature (PPO) plan covers hearing exams with a $25 copay, with routine hearing exams covered once per year. Prescription hearing aids are covered up to $500 per year with a copay between $699 and $999, but fitting/evaluation for hearing aids, OTC hearing aids, and some prescription hearing aid types are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $25 copay, and routine eye exams are covered once per year. Eyewear is covered up to 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
Freedom Blue PPO Signature (PPO) covers Medicare dental services with a $25 copay, and other dental services with a $2,000 maximum benefit per year. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, and restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with 20% coinsurance. 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 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, both with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Signature (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under 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 Equipment with varying coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Freedom Blue PPO Signature (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $10, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $250, 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 under the Freedom Blue PPO Signature (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, however, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered by the Freedom Blue PPO Signature (PPO) plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Freedom Blue PPO Signature (PPO) plan, with a $0 copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items with a maximum benefit of $140 every three months, but acupuncture, meal benefits, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, case management, institution for mental disease services, services in an intermediate care facility, case management, tobacco cessation counseling, 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 are not covered.
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