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Freedom Valor (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Valor (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Freedom Valor (PPO) in 2025, please refer to our full plan details page.
Freedom Valor (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 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 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 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 $50.00. 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 $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
Prescription drugs are not covered by Freedom Valor (PPO).
Additional Benefits
The Freedom Valor (PPO) plan offers comprehensive coverage including inpatient and outpatient hospital services, with varying copays depending on the specific service. Emergency, primary care, and preventive services are also covered, with copays ranging from $0 to $125. Additional benefits include hearing, vision, and dental services with copays and coinsurance, as well as coverage for home health services, dialysis, and medical equipment. The plan also provides coverage for skilled nursing facilities and other services such as over-the-counter items and meal benefits for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, you pay a $290 copay for days 1-7, and no copay for days 8-90; Upgrades are not covered. Inpatient Hospital Psychiatric has a $260 copay for days 1-6, and no copay for days 7-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital and Observation Services have a $325 copay, Ambulatory Surgical Center Services have a $225 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay between $5 and $5.
Partial Hospitalization See details
Freedom Valor (PPO) covers partial hospitalization with a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Freedom Valor (PPO) plan. Ground and Air Ambulance Services have a $250 copay, with no coinsurance, while 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 under the Freedom Valor (PPO) plan. Emergency Services has a $125 copay and no coinsurance, Urgently Needed Services has a $55 copay and no coinsurance, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $250 copay, all with no coinsurance.
Primary Care See details
The Freedom 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 $35 copay, mental health specialty services with a $5 copay for individual and group sessions, podiatry services with a $35 copay, and other health care professional visits with a copay between $0 and $35. The plan also covers psychiatric services with a $5 copay for individual and group sessions, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a copay between $0 and $55, and opioid treatment program services with a $5 copay.
Preventive Services See details
The Freedom Valor (PPO) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services. The plan also covers health education, fitness benefits, enhanced disease management, telemonitoring services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission 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, and counseling services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $35 copay, and for routine hearing exams with a copay between $45 and $45. Prescription hearing aids are covered with a copay between $699 and $999. The plan does not cover prescription hearing aids for the inner ear, outer ear, or over the ear, and also does not cover OTC hearing aids.
Vision Services See details
Vision Services include coverage for eye exams with a copay between $0 and $35, and routine eye exams with a $25 copay. Eyewear is covered with a combined maximum of $100 per year, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Freedom Valor (PPO) plan covers dental services, including oral exams with a $35 copay, and other dental services with a $2,000 maximum benefit per year. Restorative services and adjunctive general services have a coinsurance of 0% - 50%, while endodontics, prosthodontics (removable), prosthodontics (fixed), and oral and maxillofacial surgery have a 50% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Freedom Valor (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered. Durable Medical Equipment for use outside the home is also not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a $45 copay, and Diagnostic Radiological Services with a $150 copay. Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $45 copay. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Freedom Valor (PPO) plan with no copay and no 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 not covered by the Freedom Valor (PPO) plan. While the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, none of these services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Freedom Valor (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Freedom Valor (PPO) plan's other services benefit includes coverage for over-the-counter items with a maximum of $25 every three months, and meal benefits for chronic illnesses. Acupuncture, Dual Eligible SNPs, and several other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and others are not covered.
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