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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 2026, 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 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 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 comprehensive coverage with predictable out-of-pocket costs, featuring no copays or coinsurance for primary care visits, preventive screenings, and home health care. Specialist doctor visits require a low $10 copay, while inpatient hospital stays incur a $275 copay per stay with no coinsurance. Emergency room care is covered with a $130 copay, and urgent care visits require a $50 copay, both with no coinsurance. For supplemental health needs, the plan provides robust dental coverage up to a $2,000 annual maximum with no copay or coinsurance for most services, alongside a $400 annual eyewear allowance with no copay. Routine vision and hearing exams are available for a $10 copay, and members receive a $100 quarterly allowance for over-the-counter items with no copay. Additionally, durable medical equipment features no copays with coinsurance ranging from 0% to 50% depending on the equipment.
Inpatient Hospital See details
Freedom Blue PPO Valor (PPO) offers partially covered inpatient hospital services with no coinsurance, requiring a $275 copay per stay for acute care and a $325 daily copay for days 1 through 3 of psychiatric care, with no copay for days 4 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by Freedom Blue PPO Valor (PPO) feature no coinsurance, with a $250 copay for outpatient hospital and daily observation services, and a $200 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $5 copay and no coinsurance, while outpatient blood services are available with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Freedom Blue PPO Valor (PPO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Freedom Blue PPO Valor (PPO) covers ground and air ambulance services with a $425 copay and no coinsurance, while transportation services are partially covered with no copay and no coinsurance. Covered transportation includes 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
Freedom Blue PPO Valor (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within three days, and urgently needed services with a $50 copay, both featuring no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered with no coinsurance and copays of $130, $50, and $425, respectively.
Primary Care See details
Freedom Blue PPO Valor (PPO) provides primary care physician visits with no copay and no coinsurance, and specialist visits with a $10 copay and no coinsurance. Chiropractic services are partially covered, excluding other chiropractic services, with a $15 copay and no coinsurance, while other therapy, mental health, and podiatry services range from a $5 to $15 copay with no coinsurance.
Preventive Services See details
Freedom Blue PPO Valor (PPO) partially covers preventive services, offering annual physical exams, kidney disease education, and other screenings with no copay and no coinsurance. Additional covered benefits include remote access technologies with a $0 to $10 copay and no coinsurance, and home safety devices with 20% coinsurance and no copay, while services like health education, personal emergency response systems, and nutritional benefits are not covered.
Hearing Services See details
Freedom Blue PPO Valor (PPO) partially covers hearing services, offering annual routine hearing exams for a $10 copay and no coinsurance, though hearing aid fittings and evaluations are not covered. Prescription hearing aids are covered with a $699 to $999 copay and no coinsurance up to a $500 annual maximum, but OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Freedom Blue PPO Valor (PPO) offers partially covered vision services, featuring one routine eye exam per year for a $10 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing up to a $400 combined annual maximum benefit for contacts, frames, lenses, and upgrades.
Dental Services See details
Freedom Blue PPO Valor (PPO) offers partially covered dental services with a $2,000 annual maximum benefit for both in-network and out-of-network care. Most covered preventive and comprehensive services have no copay and no coinsurance, while Medicare-covered dental has a $10 copay and no coinsurance; however, other diagnostic, other preventive, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Freedom Blue PPO Valor (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Freedom Blue PPO Valor (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Freedom Blue PPO Valor (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copays and prior authorization required. Coinsurance costs range from no coinsurance up to 50% for DME, no coinsurance up to 20% for diabetic supplies, and a flat 20% coinsurance for prosthetics, medical supplies, and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Freedom Blue PPO Valor (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Diagnostic lab services have no copay, outpatient X-rays have a $20 copay, and diagnostic procedures, therapeutic radiology, and diagnostic radiology require copays ranging from $0 to $10, a minimum of $60, and a minimum of $225 respectively.
Home Health Services See details
Home health services are covered by Freedom Blue PPO Valor (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Freedom Blue PPO Valor (PPO) plan with no copay and no coinsurance, but only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Freedom Blue PPO Valor (PPO) with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, followed by a $218 copay per day for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Freedom Blue PPO Valor (PPO), which offers over-the-counter (OTC) items with no copay and no coinsurance up to a $100 limit every three months. Acupuncture, meal benefits, and other supplemental services under this benefit are not covered.
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