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Freedom Blue PPO Prestige (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Prestige (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 Prestige (PPO) in 2025, please refer to our full plan details page.
Freedom Blue PPO Prestige (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 Prestige (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 Prestige (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 Prestige (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $8950.00 (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 $8950.00 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 Prestige (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different amounts for your prescriptions depending on the drug tier and pharmacy you use. For example, you will pay no copay for preferred generic drugs at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Freedom Blue PPO Prestige (PPO) plan offers a wide range of benefits, including inpatient and outpatient hospital services with varying copays. You'll have access to primary care, vision, and dental services. The plan also covers ambulance and transportation services, emergency services, and home health services with no copay. Additional benefits include coverage for hearing exams and hearing aids, with a maximum benefit of $500. You'll also have access to diagnostic and radiological services, and skilled nursing facility services with copays. The plan also offers coverage for other services, such as over-the-counter items and a meal benefit for chronic illness.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $325 copay per admission, and for Inpatient Hospital Psychiatric, you will pay a $425 copay for days 1-3 and no copay for days 4-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $300 copay, observation services with a $300 copay, ambulatory surgical center (ASC) services with a $225 copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services. Outpatient blood services include an enhanced benefit, as the three-pint deductible is waived.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the Freedom Blue PPO Prestige (PPO) plan. There is no additional information provided about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Freedom Blue PPO Prestige (PPO) plan. Ground and Air Ambulance Services have a copay of $315.00, and there is no coinsurance. Transportation Services to any health-related location other than a plan-approved location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Freedom Blue PPO Prestige (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $35 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $35 copay, and Worldwide Emergency Transportation has a $315 copay.
Primary Care See details
Freedom Blue PPO Prestige (PPO) covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services, and mental health specialty services with a $40 copay for both individual and group sessions. The plan also covers podiatry services, other health care professional services, psychiatric services with a $40 copay for both individual and group sessions, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a $0-$40 copay, and opioid treatment program services with a $40 copay.
Preventive Services See details
The Freedom Blue PPO Prestige (PPO) plan covers a variety of preventive services, including Medicare-covered preventive services, annual physical exams, and additional preventive services. Additional preventive services may have coinsurance. Some services, such as Health Education, In-Home Safety Assessment, and Counseling Services, are not covered. Home and Bathroom Safety Devices and Modifications have a 20% coinsurance.
Hearing Services See details
Freedom Blue PPO Prestige (PPO) covers routine hearing exams once per year and prescription hearing aids with a copay between $699 and $999 per year, up to a maximum of $500. 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
The Freedom Blue PPO Prestige (PPO) plan covers vision services, including routine eye exams with no deductible and one visit per year. Eyewear is covered up to a combined maximum of $350 every 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
The Freedom Blue PPO Prestige (PPO) plan covers dental services with a maximum benefit of $3,500 per year, including oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. 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 Prestige (PPO) plan, with a $35 copay for Medicare Part B Insulin Drugs, and coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Prestige (PPO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with coinsurance, including 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 are covered, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $150, 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 Prestige (PPO) plan with no copay or coinsurance, but require authorization. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services are covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Freedom Blue PPO Prestige (PPO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay per day for days 21-100.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $75 every three months, and a Meal Benefit for chronic illness; however, acupuncture, Dual Eligible SNPs, 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 are not covered.
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