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Freedom Nation Prestige (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Nation Prestige (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Freedom Nation Prestige (PPO) in 2025, please refer to our full plan details page.
Freedom Nation Prestige (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 Prestige (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 Prestige (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 Prestige (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $52.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $4.00. 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.
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 Prestige (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you'll pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay no copay for preferred generic drugs at a preferred pharmacy, while standard generic drugs have 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Freedom Nation Prestige (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays, as well as coverage for emergency services, primary care, and preventive services. The plan includes no copay for home health services, and also offers additional benefits like hearing, vision, and dental services with copays and coinsurance varying based on the service. However, some services, such as additional hours of care, certain hearing aids, and specific dental services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered under the Freedom Nation Prestige (PPO) plan. For Inpatient Hospital-Acute, you will pay a $305 copay for days 1-6, and no copay for days 7-90, with a service-specific out-of-pocket maximum of $1830. Inpatient Hospital Psychiatric also has a $305 copay for days 1-6, and no copay for days 7-90, with a service-specific out-of-pocket maximum of $1830.
Outpatient Services See details
Outpatient Services are covered by the Freedom Nation Prestige (PPO) plan, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $350 copay, ASC services have a $250 copay, and individual and group outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Freedom Nation Prestige (PPO) plan. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Freedom Nation Prestige (PPO) plan. Ground and Air Ambulance Services have a copay of $325, and there is no coinsurance; however, 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 Prestige (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $325 copay.
Primary Care See details
The Freedom Nation Prestige (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services, physician specialist services with a $10 copay, and mental health specialty services with a $40 copay for individual and group sessions. The plan also covers podiatry services with a $10 copay, other health care professional services with a copay between $0 and $10, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $10 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 Prestige (PPO) plan covers preventive services, including Medicare-covered services, annual physical exams, health education, fitness benefits, enhanced disease management, telemonitoring services, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following 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, 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, or counseling services.
Hearing Services See details
Hearing Services are covered under the Freedom Nation Prestige (PPO) plan. Hearing Exams have a $10 copay, and Routine Hearing Exams have a copay of $25, and Fitting/Evaluation for Hearing Aids has no copay. Prescription Hearing Aids are partially covered; Prescription Hearing Aids (all types) have a copay between $699 and $999, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC Hearing Aids are also not covered.
Vision Services See details
Vision services include routine eye exams with a copay of $0-$10, and eyewear benefits which include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $10 copay. Other services, such as oral exams, are covered with a maximum benefit of $3,000 per year, and a $0-$10 copay and 0-50% coinsurance for other services such as restorative services, endodontics, and prosthodontics. However, 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 Prestige (PPO) plan, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with 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 by the Freedom Nation Prestige (PPO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, while Prosthetic Devices and Medical Supplies have a 20% coinsurance; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a $50 copay for Medicare-covered lab services, while lab services are not covered. Diagnostic Procedures/Tests have a $50 copay. Radiological Services include coverage for diagnostic and therapeutic radiological services, and outpatient X-ray services, with a $200 copay for diagnostic radiological services, 20% coinsurance for therapeutic radiological services, and a $50 copay for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. The copay for covered services is listed separately.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Freedom Nation Prestige (PPO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Services for additional days beyond Medicare-covered SNF and non-Medicare-covered stays are not covered.
Other Services See details
Under Other Services, 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. Over-the-counter (OTC) items are covered with a maximum plan benefit of $75.00 every three months. The plan also provides a meal benefit for chronic illnesses.
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