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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 range of benefits, including inpatient hospital stays with a $275 copay, outpatient services, and ambulance services with a $300 copay. You'll also have access to primary care with copays ranging from $5 to $15, as well as vision and dental coverage. This plan includes coverage for preventive services, hearing exams with a $10 copay, and a yearly eyewear benefit of $400. Additionally, you'll find coverage for home infusion, dialysis, medical equipment, and skilled nursing facility services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Inpatient Hospital-Acute has a $275 copay, and Additional Days for Inpatient Hospital-Acute has no copay. Inpatient Hospital Psychiatric has a $325 copay for days 1-3, and no copay for days 4-90. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services and observation services with a $250 copay, ambulatory surgical center services with a $200 copay, and outpatient substance abuse services with a $5 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Freedom Blue PPO Valor (PPO) plan. The details of the coverage are not provided in this snippet.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Freedom Blue PPO Valor (PPO) plan. Ground and air ambulance services have a $300 copay, and transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Freedom Blue PPO Valor (PPO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $50 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $300 copay; all of these services have no coinsurance.
Primary Care See details
The Freedom Blue PPO Valor (PPO) plan covers primary care physician services, 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 chiropractic care is limited to 8 visits per year.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services, annual physical exams, and additional preventive services. Additional preventive services include coverage for Home and Bathroom Safety Devices and Modifications with 20% coinsurance, and Remote Access Technologies with a copay of $0-$10. Other services like Health Education, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $10 copay, routine hearing exams limited to 1 per year, and prescription hearing aids with a copay between $699 and $999, limited to 2 per year, with a maximum benefit of $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 a yearly benefit of $400 for eyewear, covering contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Freedom Blue PPO Valor (PPO) plan covers dental services, including oral exams with a $10 copay, dental x-rays, prophylaxis (cleaning), and fluoride treatment. The plan also covers restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, each with a 20% coinsurance. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%, Medicare Part B Chemotherapy/Radiation Drugs with coinsurance between 0% and 20%, and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Valor (PPO) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the Freedom Blue PPO Valor (PPO) plan, with Durable Medical Equipment (DME) subject to a 20% coinsurance and requiring authorization. Prosthetic devices and medical supplies have a 20% coinsurance and require authorization, while diabetic supplies have a 0-20% coinsurance and diabetic therapeutic shoes/inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Freedom Blue PPO Valor (PPO) plan. While all diagnostic services are covered with no copay, diagnostic procedures/tests and lab services are not covered. Radiological Services are covered with a copay: up to $225 for Diagnostic Radiological Services, up to $60 for Therapeutic Radiological Services, and $20 for Outpatient X-Ray Services.
Home Health Services See details
Home Health Services are covered by the Freedom Blue PPO Valor (PPO) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but in practice, 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, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $100 every three months, however, 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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