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Freedom Nation (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Nation (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Freedom Nation (PPO) in 2025, please refer to our full plan details page.
Freedom Nation (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2025 to people living in Western New York. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Freedom Nation (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 Nation (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 Nation (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $30.00. 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 $10100.00 (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 $10100.00 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 Nation (PPO) plan has an enhanced alternative drug benefit with a $0 deductible. In the initial coverage phase, you'll pay a $5 copay for preferred generic drugs at preferred pharmacies, and a $17 copay at standard pharmacies. For preferred brand drugs, you'll pay 49% coinsurance. For non-preferred drugs, you'll pay 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Freedom Nation (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. You'll pay a copay for services like hospital stays, outpatient care, and specialist visits, but some services, such as preventive services, offer no copay. This plan also includes coverage for ambulance services, emergency care, and home health services, along with vision, hearing, and dental benefits. The plan provides coverage for prescription hearing aids, and offers a maximum annual benefit for eyewear and dental services. Other services like skilled nursing facilities and home infusion are covered with specific copays or coinsurance, while some services like cardiac rehabilitation and certain dental and vision procedures are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $375 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $370 copay for days 1-5, and no copay for days 6-90. Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for the Freedom Nation (PPO) plan includes coverage for Outpatient Hospital Services with a $375 copay, Observation Services with a $375 copay, Ambulatory Surgical Center (ASC) Services with a $275 copay, and Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions. Outpatient Blood Services are also covered, with the three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the Freedom Nation (PPO) plan. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Freedom Nation (PPO) plan. Both ground and air ambulance services have a $325 copay, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Freedom Nation (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Transportation has a $325 copay; all services have no coinsurance.
Primary Care See details
The Freedom Nation (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy, physician specialist services with a $30 copay, mental health specialty services with a $40 copay for individual or group sessions, podiatry services with a $30 copay, other health care professionals, psychiatric services with a $40 copay for individual or group sessions, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay between $0 and $55, and opioid treatment program services with a $40 copay.
Preventive Services See details
The Freedom Nation (PPO) plan covers preventive services, including annual physical exams, health education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. However, the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, remote access technologies, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay, routine hearing exams (1 per year) with a copay between $45 and $45, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $699 and $999 for all types, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$30, and routine eye exams with a $25 copay for one visit every year. Eyewear is covered with a combined maximum benefit of $100 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Freedom Nation (PPO) plan covers dental services, including oral exams with a $30 copay, and other dental services with a $2,000 maximum benefit per year. Restorative services and adjunctive general services have a coinsurance between 0% and 50%, while Endodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery have a 50% coinsurance. Orthodontic services, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Freedom Nation (PPO) plan, with a $35 copay for Medicare Part B Insulin Drugs. The coinsurance for Medicare Part B drugs is between 0% and 20%, with the specific amount depending on the drug.
Dialysis Services See details
Dialysis Services are covered under the Freedom Nation (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a coinsurance between 0% and 20% and Prosthetic Devices and Medical Supplies with a 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies and Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Freedom Nation (PPO) plan. Diagnostic Procedures/Tests have a $50 copay, and Lab Services have a $5 copay. Diagnostic Radiological Services have a copay of at most $200, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Freedom Nation (PPO) plan, with no copay or coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Freedom Nation (PPO) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Freedom Nation (PPO) plan, but require prior authorization. For days 1-20, there is no copay, while days 21-100 have a $214 copay; additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Freedom Nation (PPO) plan's "Other Services" benefit covers over-the-counter (OTC) items with a maximum benefit coverage amount of $160 every three months; however, acupuncture, 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. The plan also provides a meal benefit for chronic illnesses.
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