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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 an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a $0 copay for preferred generic drugs at a preferred pharmacy, and 25% coinsurance for standard generic drugs at both preferred and standard pharmacies. You will pay 50% coinsurance for preferred brand drugs, and 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Freedom Blue PPO Prestige (PPO) plan provides coverage for a variety of healthcare services, including inpatient and outpatient hospital care, with varying copays. The plan also includes benefits for primary care, preventive services, vision, hearing, and dental care, with specific coverage limits and cost-sharing. Emergency services, ambulance services, and home health services are covered, along with some medical equipment and diagnostic services, with copays and coinsurance applying to certain services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Freedom Blue PPO Prestige (PPO) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. Inpatient Hospital-Acute has a $325 copay per admission or stay, and additional days have no copay. Inpatient Hospital Psychiatric has a $425 copay for days 1-3, and no copay for days 4-90. Non-Medicare-covered stay and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered by the Freedom Blue PPO Prestige (PPO) plan, including all outpatient hospital services, with a $300 copay for Outpatient Hospital Services and Observation Services. Ambulatory Surgical Center (ASC) Services have a $225 copay, while both individual and group sessions for outpatient substance abuse have a copay of $40.00. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the Freedom Blue PPO Prestige (PPO) plan. There is no information about the cost of these services available.
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, and there is no coinsurance. Transportation services to a plan-approved health-related location are covered, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including 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
The Freedom Blue PPO Prestige (PPO) plan covers primary care physician services, chiropractic services (with a $20 copay), occupational therapy services (with a $20 copay), physician specialist services, mental health specialty services (with a $40 copay for individual and group sessions), podiatry services, other health care professional services, psychiatric services (with a $40 copay for 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). Routine chiropractic care is limited to 8 visits per year.
Preventive Services See details
The Freedom Blue PPO Prestige (PPO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, and additional preventive services. Fitness benefits, enhanced disease management, remote access technologies, home and bathroom safety devices (20% coinsurance), and kidney disease education are also covered. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Freedom Blue PPO Prestige (PPO) covers hearing exams and prescription hearing aids, with routine hearing exams covered for one visit per year. Prescription hearing aids have a maximum benefit of $500 per year, with a copay between $699 and $999. Fitting/evaluation for hearing aids, prescription hearing aids - inner ear, outer ear, and 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 eye exams with no deductible, routine eye exams once per year, and eyewear with a combined maximum benefit of $350 per year. 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 offers a yearly maximum of $3,500 for dental services, covering oral exams, dental x-rays, prophylaxis, fluoride treatments, 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. This includes coverage for Medicare Part B Insulin Drugs with a $35 copay, and a coinsurance between 0% and 20%, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Prestige (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Freedom Blue PPO Prestige (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a coinsurance between 20% and 20%, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Freedom Blue PPO Prestige (PPO) plan. Diagnostic Procedures/Tests and Lab Services are not covered, while 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 and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but 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 Prestige (PPO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF stays, and non-Medicare-covered SNF stays are not covered.
Other Services See details
The "Other Services" additional benefit for Freedom Blue PPO Prestige (PPO) covers Over-the-Counter (OTC) Items with a maximum benefit of $75 every three months, and Meal Benefits for chronic illnesses. 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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