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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 2026, 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 4.5 out of 5 stars in 2026.
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 robust healthcare coverage featuring no copays or coinsurance for primary care visits, home health services, and routine preventive care. For specialized medical needs, members pay a $35 copay for specialist visits and a $290 daily copay for the first seven days of inpatient hospital stays, with no coinsurance. Emergency care is available with a $130 copay, which is waived if admitted, while outpatient hospital services carry a $325 copay. This Medicare plan also includes valuable supplemental benefits, such as preventive dental care with no copay up to a $2,000 annual limit and a $100 annual allowance for eyewear. Routine hearing exams require a $35 copay, while prescription hearing aids are covered with copays ranging from $699 to $999. Additionally, skilled nursing facility stays feature no copay for the first 20 days, and members receive a $40 allowance every three months for over-the-counter items.
Inpatient Hospital See details
Freedom Valor (PPO) offers partially covered inpatient hospital services with no coinsurance, though prior authorization is required. For acute care, there is a $290 daily copay for days 1-7 and no copay for days 8 and beyond, but room upgrades are not covered. Psychiatric care requires a $260 daily copay for days 1-6 and no copay for days 7-90, while additional psychiatric days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Freedom Valor (PPO) covers outpatient services with no coinsurance, featuring a $325 copay for outpatient hospital and observation services and a $225 copay for ambulatory surgical center services. Outpatient substance abuse services require a $5 copay per individual or group session, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Freedom Valor (PPO) with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Freedom Valor (PPO) covers Medicare-covered ground and air ambulance services with a $385.00 copay and no coinsurance, subject to prior authorization. Although transportation services are technically covered, trips to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Freedom Valor (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within one day, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $40 to $385.
Primary Care See details
Freedom Valor (PPO) primary care benefits feature no copay and no coinsurance for primary care physician visits, while specialist visits require a $35 copay and no coinsurance. Physical, occupational, and speech therapy services have a $15 copay and no coinsurance, and chiropractic services are partially covered with routine care costing a $15 copay and no coinsurance while other chiropractic services are not covered.
Preventive Services See details
Freedom Valor (PPO) covers preventive services, such as annual physical exams, kidney education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Freedom Valor (PPO) hearing services are partially covered, featuring routine hearing exams with a $35 copay and no coinsurance, and prescription hearing aids with a $699 to $999 copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Freedom Valor (PPO) covers vision services with no deductible, offering one routine eye exam per year with a copay of $0 to $35 and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing a combined annual maximum benefit of $100 for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Freedom Valor (PPO), which features a $35 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive services up to a $2,000 annual maximum. Comprehensive services like restorative and endodontic care are covered with no copay and 50% coinsurance (0% to 50% for adjunctive services), though implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Freedom Valor (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require between no coinsurance and 20% coinsurance, while Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Freedom Valor (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Freedom Valor (PPO) partially covers medical equipment with no copays, excluding diabetic supplies and diabetic therapeutic shoes or inserts which are not covered. Covered durable medical equipment incurs a 0% to 50% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic equipment has no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Freedom Valor (PPO) with prior authorization, offering lab services with no copay or coinsurance, and diagnostic tests with a $0 to $10 copay and no coinsurance. Diagnostic radiological services require a copay starting at $150, outpatient X-rays have a $45 copay with coinsurance, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Freedom Valor (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Freedom Valor (PPO) provides coverage for Cardiac Rehabilitation Services with no coinsurance and a $15 copay; however, while some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Freedom Valor (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the 100-day limit are not covered.
Other Services See details
Other services are partially covered by the Freedom Valor (PPO) plan, which offers over-the-counter (OTC) items up to $40 every three months and a chronic illness meal benefit, both with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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