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Freedom Blue PPO Valor (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Valor (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 Valor (PPO) in 2025, please refer to our full plan details page.
Freedom Blue PPO Valor (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 Valor (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Freedom Blue PPO Valor (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 Valor (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 $75.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Freedom Blue PPO Valor (PPO).
Additional Benefits
The Freedom Blue PPO Valor (PPO) plan offers a wide range of benefits, including inpatient and outpatient hospital services, with varying copays. You will have no copay for primary care physician visits, but other services like specialist visits, chiropractic, and vision exams have copays. Dental services are covered with a $2,000 annual maximum benefit, and hearing services are covered. This plan also covers ambulance services, emergency services, and home health services. Additionally, you'll have access to preventive services, and coverage for medical equipment, home infusion services, and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, though prior authorization is required. For Inpatient Hospital-Acute, there is a $275 copay per admission, with additional days covered at no copay, and non-Medicare-covered stays and upgrades are not covered. Inpatient Hospital Psychiatric has a $325 copay for days 1-3, and no copay for days 4-90, while additional days and non-Medicare-covered stays 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 $250 copay, Ambulatory Surgical Center Services have a $200 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay between $5.00 and $5.00. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered under the Freedom Blue PPO Valor (PPO) plan. There is no information available about the cost of these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both Ground and Air Ambulance Services, each with a $300 copay. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year, with the mode of transportation including taxi, medical transport, and other options. Transportation Services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $125 copay and no coinsurance, Urgently Needed Services has a $50 copay and no coinsurance, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
The Freedom Blue PPO Valor (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $15 copay, physician specialist services with a $10 copay, mental health specialty services with a $5 copay, podiatry services with a $10 copay, other health care professional services with a copay between $0 and $10, psychiatric services with a $5 copay, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a copay between $0 and $50, and opioid treatment program services with a $5 copay. Routine foot care is covered with a $10 copay for up to 10 visits per year.
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 a coinsurance of 20% for Home and Bathroom Safety Devices and Modifications, and a copay of $0-$10 for Remote Access Technologies. The plan does not cover services such as 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.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $10 copay, and prescription hearing aids with a copay between $699 and $999, up to $500 per year for both in-network and out-of-network services. 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 include eye exams with a $10 copay, and eyewear with a combined maximum benefit of $400 every year for both in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Freedom Blue PPO Valor (PPO) plan covers dental services with a $10 copay for Medicare dental services, and a $2,000 annual maximum benefit. Other dental services include oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with 20% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, you will pay a $35 copay plus 0-20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Valor (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the Freedom Blue PPO Valor (PPO) plan. Durable medical equipment has a 20% coinsurance with no copay, while durable medical equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance with no copay, and medical supplies have a 20% coinsurance with no copay. Diabetic supplies have between 0% and 20% coinsurance, and diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The Freedom Blue PPO Valor (PPO) plan covers diagnostic and radiological services, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $225, Therapeutic Radiological Services have a copay of at most $60, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Freedom Blue PPO Valor (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 technically covered, but 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) services are covered under the Freedom Blue PPO Valor (PPO) plan, with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered. Prior authorization is required.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, with a maximum benefit of $100 every three months. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, 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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