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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 $154.00. 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, meaning your benefits start right away. For Tier 1 preferred generic drugs, you pay no copay for a one-month supply at preferred pharmacies or a three-month supply through preferred mail order. Tier 2 generic medications cost an $11 copay for a one-month supply at preferred pharmacies, compared to a $19 copay at standard pharmacies. Tier 3 preferred brand drugs require a $45 copay for a one-month supply at preferred pharmacies, while Tier 4 non-preferred drugs have a $100 copay at both preferred and standard locations. If you need Tier 5 specialty tier medications, you will pay a 33% coinsurance for a one-month supply across all pharmacy options. Ordering a three-month supply of Tier 3 or Tier 4 drugs through preferred mail order provides additional savings with copays of $115 and $275, respectively.
Additional Benefits
The Freedom Blue PPO Standard (PPO) plan offers robust healthcare coverage featuring no copay for primary care visits, home health services, and annual preventive care. For more intensive medical needs, members pay a $150 daily copay for the first seven days of inpatient hospital stays and a $150 copay for outpatient hospital services, both with no coinsurance. Emergency room visits require a $130 copay, which is waived if admitted, while urgent care is available for a $50 copay. Members also benefit from affordable specialty care, including a $35 copay for specialist visits, routine vision exams, and routine hearing exams, alongside a $15 copay for basic dental services. The plan covers essential medical equipment and dialysis services with no copay and a standard 20% coinsurance. Additionally, covered eyewear is provided with no copay up to a $425 annual limit, and skilled nursing facility stays require no copay for the first 20 days.
Inpatient Hospital See details
Freedom Blue PPO Standard (PPO) covers inpatient hospital services with no coinsurance, requiring a $150 daily copay for days 1 through 7 and no copay for days 8 through 90. This benefit is partially covered as it excludes upgrades, non-Medicare-covered stays, and additional psychiatric days.
Outpatient Services See details
Freedom Blue PPO Standard (PPO) covers outpatient hospital and observation services with a $150 copay and no coinsurance, and ambulatory surgical center services with a $100 copay and no coinsurance. Outpatient substance abuse services are covered with a $35 copay and no coinsurance per individual or group session, while outpatient blood services are available with no copay, no deductible, and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Freedom Blue PPO Standard (PPO) plan 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. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved health-related locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under Freedom Blue PPO Standard (PPO) are covered with a $130 copay and no coinsurance, with the copay waived if admitted to the hospital within three days. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $50, and $330 respectively.
Primary Care See details
Freedom Blue PPO Standard (PPO) provides primary care physician services with no copay and no coinsurance, while specialist and therapy visits require a $35 copay and no coinsurance. Chiropractic services are partially covered, offering routine care with a $15 copay and no coinsurance for up to 8 visits per year, though other chiropractic services are not covered.
Preventive Services See details
Freedom Blue PPO Standard (PPO) covers preventive services, including annual physical exams, kidney disease education, and other screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, featuring remote access technologies with a $0 to $35 copay and no coinsurance, and home safety devices with a 20% coinsurance and no copay, while services like health education, personal emergency response systems, and nutritional benefits are not covered.
Hearing Services See details
Hearing services are partially covered by Freedom Blue PPO Standard (PPO), which offers one annual routine hearing exam for a $35 copay and no coinsurance. Prescription hearing aids are covered up to a $500 annual maximum with no coinsurance and a copay of $399 to $699, while hearing aid fittings, evaluations, OTC hearing aids, and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Freedom Blue PPO Standard (PPO) partially covers vision services because other eye exam services are not covered, but it provides one routine eye exam per year with a $35 copay and no coinsurance. Covered eyewear, such as contacts, eyeglasses, and upgrades, has no copay, no coinsurance, and no deductible, up to a combined maximum benefit of $425 per year.
Dental Services See details
Freedom Blue PPO Standard (PPO) partially covers dental services, offering Medicare-covered dental services for a $35 copay and no coinsurance, and other dental services for a $15 copay and no coinsurance. While cleanings, oral exams, x-rays, and adjunctive general services are covered with no coinsurance, other diagnostic services, fluoride, restorative, 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 is required. Under this benefit, Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under Freedom Blue PPO Standard (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Freedom Blue PPO Standard (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and generally 20% coinsurance, though diabetic supplies range from no coinsurance to 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Freedom Blue PPO Standard (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Members pay no copay for lab services, up to a $10 copay for diagnostic procedures, a $25 copay for outpatient X-rays, and minimum copays of $75 and $60 for diagnostic and therapeutic radiological services, respectively.
Home Health Services See details
Home Health Services are covered by Freedom Blue PPO Standard (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Freedom Blue PPO Standard (PPO) covers some services under Cardiac Rehabilitation Services with no copay and no coinsurance, 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
Freedom Blue PPO Standard (PPO) covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Freedom Blue PPO Standard (PPO) partially covers other services, providing a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and other additional services are not covered.
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