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Freedom Blue PPO Standard (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Standard (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 Standard (PPO) in 2026, please refer to our full plan details page.
Freedom Blue PPO Standard (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2026 to people living in West Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Freedom Blue PPO Standard (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 Standard (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 Standard (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $134.00. 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 $10000.00 (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 $10000.00 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 Standard (PPO) plan offers prescription drug coverage with a $0 drug deductible, allowing your benefits to start immediately. For Tier 1 preferred generic medications, you will pay no copay when using a preferred pharmacy or preferred mail order service. Tier 2 generic drugs are also highly affordable, costing an $11 copay for a 1-month supply at a preferred pharmacy compared to a $19 copay at standard pharmacies. For brand-name and specialty medications, Tier 3 preferred brand drugs require a $45 copay for a 1-month supply at preferred pharmacies, while Tier 4 non-preferred drugs have a $100 copay. Specialty drugs in Tier 5 require a 33% coinsurance for a 1-month supply across all pharmacy options. You can further reduce your out-of-pocket expenses for Tiers 1 through 4 by utilizing preferred mail order services for a 3-month supply.
Additional Benefits
The Freedom Blue PPO Standard (PPO) plan offers affordable access to essential medical care, featuring no copays or coinsurance for primary care visits, home health services, and preventive care. Specialist visits and routine vision exams require a low $35 copay, while inpatient hospital stays are covered with a $150 daily copay for the first seven days and no copay thereafter. Emergency care is accessible with a $130 copay, which is waived if you are admitted to the hospital. For specialized treatments, the plan covers diagnostic lab services and home infusion with no copay, while dialysis and durable medical equipment require a 20% coinsurance. Routine vision eyewear is covered with no copay up to a $425 annual limit, and prescription hearing aids are available with copays ranging from $399 to $699. While the plan offers robust coverage for basic services, it is important to note that over-the-counter items and major dental procedures are not covered.
Inpatient Hospital See details
Freedom Blue PPO Standard (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $150 daily copay for days 1 through 7 and no copay for days 8 through 90. Unlimited additional acute days are covered, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Freedom Blue PPO Standard (PPO) with no coinsurance, featuring a $150 copay for outpatient hospital and observation services, and a $100 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $35 copay with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Freedom Blue PPO Standard (PPO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Freedom Blue PPO Standard (PPO) covers ground and air ambulance services with a $330 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Freedom Blue PPO Standard (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 3 days, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent services are also covered with no coinsurance, featuring copays of $130 for emergency care, $50 for urgent care, and $330 for emergency transportation.
Primary Care See details
Freedom Blue PPO Standard (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, mental health, and podiatry visits require a $35 copay and no coinsurance. Chiropractic benefits are partially covered, offering routine care for a $15 copay and no coinsurance but excluding other chiropractic services, with telehealth also available for a $0 to $50 copay and no coinsurance.
Preventive Services See details
Freedom Blue PPO Standard (PPO) partially covers preventive services, offering annual physical exams, kidney disease education, and routine screenings with no copay and no coinsurance. While remote access technologies (copay of $0 to $35), memory fitness, and home safety devices (20% coinsurance) are covered, other services like health education, personal emergency response systems, and nutritional therapy are not covered.
Hearing Services See details
Freedom Blue PPO Standard (PPO) provides partially covered hearing services, featuring routine hearing exams for a $35 copay and no coinsurance, alongside prescription hearing aids with a $399 to $699 copay, no coinsurance, and a $500 annual coverage limit. Fitting and evaluation services, over-the-counter (OTC) hearing aids, and inner, outer, or over-the-ear prescription hearing aid types are not covered.
Vision Services See details
Freedom Blue PPO Standard (PPO) vision services are partially covered, excluding other eye exam services, and feature one annual routine eye exam for a $35 copay and no coinsurance. Eyewear is covered with no copay, no coinsurance, and no deductible up to a combined maximum benefit of $425 per year for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Freedom Blue PPO Standard (PPO), with Medicare-covered dental requiring a $35 copay and no coinsurance, and other dental services requiring a $15 copay and no coinsurance. While cleanings, exams, X-rays, and adjunctive general services are covered with no coinsurance, several services—including fluoride, restorative care, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics—are not covered.
Home Infusion bundled Services See details
Freedom Blue PPO Standard (PPO) covers home infusion bundled services with no copay, although prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs carry no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Freedom Blue PPO Standard (PPO) with no copay and a 20% coinsurance. This coverage helps you easily manage your out-of-pocket costs for essential dialysis treatments.
Medical Equipment See details
Freedom Blue PPO Standard (PPO) covers medical equipment with no copays, though prior authorization is required. Members pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies from specified manufacturers range from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
Freedom Blue PPO Standard (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Diagnostic lab services have no copay, other diagnostic tests require a $0 to $10 copay, and radiological services carry copays of $25 for X-rays, at least $60 for therapeutic radiology, and at least $75 for diagnostic radiology.
Home Health Services See details
Freedom Blue PPO Standard (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Freedom Blue PPO Standard (PPO) offers cardiac rehabilitation services with no copay and no coinsurance. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Freedom Blue PPO Standard (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires prior authorization, without requiring a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Freedom Blue PPO Standard (PPO) partially covers other services, offering a chronic illness meal benefit with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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