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Freedom Blue PPO Merit (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Merit (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 Merit (PPO) in 2025, please refer to our full plan details page.
Freedom Blue PPO Merit (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2025 to people living in WV 2 Region. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Freedom Blue PPO Merit (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 Merit (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 Merit (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 $76.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $150.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $13000.00 (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 $13000.00 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 Merit (PPO) plan has an "Enhanced Alternative" drug benefit. The plan has a deductible of $590. After the deductible is met, you will pay a copay or coinsurance for your prescriptions based on the drug tier and pharmacy you use. For preferred generic drugs, you'll pay a $10 copay at a preferred pharmacy or a $20 copay at a standard pharmacy. Standard generic and preferred brand drugs have a 21% coinsurance, and non-preferred drugs have a 25% coinsurance. Once 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 Merit (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services, including primary care, have copays ranging from $0 to $350. Emergency, ambulance, and transportation services are covered with copays, and preventive services are covered with no copay. The plan also includes coverage for hearing, vision, and dental services, with copays and coinsurance depending on the specific service. Additional benefits include home health services with no copay, and skilled nursing facility stays, with copays for specific days. The plan has some exclusions, such as certain services like acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute, which has a $455 copay for days 1-5 and no copay for days 6-90, and Inpatient Hospital Psychiatric, which has a $645 copay for days 1-3 and no copay for days 4-90. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, nor are Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a $350 copay, Ambulatory Surgical Center (ASC) Services with a $300 copay, and both Individual and Group Sessions for Outpatient Substance Abuse with a copay between $40 and $40. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Freedom Blue PPO Merit (PPO) plan. There is a $60 copay for this benefit.
Ambulance and Transportation Services See details
The Freedom Blue PPO Merit (PPO) plan covers ambulance and transportation services, including ground and air ambulance services, each with a $215 copay. Transportation services to a plan-approved health-related location are also covered, including transportation via sedan, stretcher van, or wheelchair van. 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 under the Freedom Blue PPO Merit (PPO) plan. Emergency Services has a $110 copay, and Urgently Needed Services has a $45 copay, while Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $215 copay.
Primary Care See details
The Freedom Blue PPO Merit (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $45 copay, and mental health specialty services with a $40 copay for individual or group sessions. The plan also covers podiatry services and other health care professional services with a copay ranging from $0 to $45, psychiatric services with a $40 copay for individual or group sessions, physical therapy and speech-language pathology services with a $45 copay, additional telehealth benefits, and opioid treatment program services with a $40 copay.
Preventive Services See details
Preventive services, including Medicare-covered services and an annual physical exam, are covered. Additional preventive services include coverage for remote access technologies with a copay between $0 and $45, and home and bathroom safety devices with 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Hearing exams have a $45 copay, and routine hearing exams are limited to 1 per year with a copay between $40 and $40. Prescription hearing aids have a maximum benefit of $500 per year, and prescription hearing aids (all types) have a copay between $699 and $999 for up to 2 visits per year. Fitting/evaluation for hearing aids, 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 includes coverage for eye exams with a $45 copay, and eyewear with a combined maximum benefit of $350 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Freedom Blue PPO Merit (PPO) plan covers Medicare Dental Services with a $45 copay, and other dental services, subject to a $1,000 annual maximum. Oral exams, dental x-rays, cleaning, and fluoride treatments are covered, with a limit of 1 visit every six months for exams, and 1 visit per year for x-rays and cleaning. Restorative services, endodontics, periodontics, prosthodontics, fixed, and oral and maxillofacial surgery are covered with a 20% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Merit (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Freedom Blue PPO Merit (PPO) plan. Durable Medical Equipment has a 20% coinsurance with no copay, but equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance with no copay. Diabetic equipment benefits are covered, with coinsurance varying by supply and service, and a 0-20% coinsurance for diabetic supplies, and a 20% coinsurance for therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Freedom Blue PPO Merit (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, Lab Services have no copay, Diagnostic Radiological Services have a copay of at least $300, Therapeutic Radiological Services have a copay of at least $60, and Outpatient X-Ray Services have a $75 copay.
Home Health Services See details
Home Health Services are covered under the Freedom Blue PPO Merit (PPO) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. There is a copay for some services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Freedom Blue PPO Merit (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 for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered by the Freedom Blue PPO Merit (PPO) plan, including acupuncture, over-the-counter items, meal benefits, and several other services. No authorization or referrals are required for these services.
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