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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.
This summary reflects 2025 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Freedom Blue PPO Merit (PPO) is a PPO plan offered by Highmark Health available for the 2025 plan year 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 $99.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $50.00 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 that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $8300.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $8300.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $13000.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $13000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $10 copay at preferred pharmacies and a $20 copay at standard pharmacies. For standard generic and preferred brand drugs, you will pay 21% coinsurance. Non-preferred drugs have a 25% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Freedom Blue PPO Merit (PPO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services and ambulatory surgical centers have copays as well. Ambulance services, emergency services, primary care visits, and vision and dental services are covered with copays, while some services like diagnostic and radiological services and skilled nursing facilities may have coinsurance or copays depending on the service. Preventive services, hearing exams, and home health services are covered under this plan. The plan also offers coverage for home infusion services, dialysis, and medical equipment. However, some services, such as cardiac rehabilitation, and other services like acupuncture, over-the-counter items, and meal benefits, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $400 copay for days 1-5, and no copay for days 6-90, and for Inpatient Hospital Psychiatric, there is a $645 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 all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital and Observation Services have a $350 copay, Ambulatory Surgical Center Services have a $300 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a $40 copay.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $60 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Freedom Blue PPO Merit (PPO) plan. Ground and Air Ambulance Services have a $150 copay, and Transportation Services to a Plan Approved Health-related Location are covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Freedom Blue PPO Merit (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $150 copay; all have no coinsurance. Worldwide Urgent Coverage has a $45 copay and no coinsurance.
Primary Care See details
Freedom Blue PPO Merit (PPO) covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $25 copay, physician specialist services with a $35 copay, and mental health specialty services with a $40 copay for individual and group sessions. The plan also covers podiatry services with a $35 copay, other health care professional services with a copay between $0 and $35, 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 $45, and opioid treatment program services with a $40 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, and additional preventive services. Additional preventive services may include services with a copay and/or coinsurance, such as Home and Bathroom Safety Devices and Modifications with 20% coinsurance, and Remote Access Technologies with a copay between $0 and $35. Health Education, In-Home Safety Assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, 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 Benefits, 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. The plan also covers Fitness Benefits, Enhanced Disease Management, Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit.
Hearing Services See details
Hearing exams are covered under the Freedom Blue PPO Merit (PPO) plan with a $35 copay, and routine hearing exams are covered with a copay between $40 and $40. Prescription hearing aids are covered with a maximum plan benefit of $500 per year, and Prescription Hearing Aids (all types) have a copay between $699 and $999. 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 are covered by the Freedom Blue PPO Merit (PPO) plan, including routine eye exams with a $35 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 $35 copay. Other dental services are covered, including oral exams, dental x-rays, cleaning, and fluoride treatment; all have limitations on the number of visits and periodicity. Restorative Services, Endodontics, Periodontics, Prosthodontics, removable, 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 by the Freedom Blue PPO Merit (PPO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay. Coinsurance amounts vary between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Merit (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the Freedom Blue PPO Merit (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Prosthetics/Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. 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 or 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 not covered by the Freedom Blue PPO Merit (PPO) plan. This 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
Skilled Nursing Facility (SNF) benefits are covered by the Freedom Blue PPO Merit (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, there is a $214 copay.
Other Services See details
Other Services, including acupuncture, over-the-counter items, meal benefits, and other listed services, are not covered by the Freedom Blue PPO Merit (PPO) plan. No authorization or referrals are required for any of the services.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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