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Freedom Blue PPO Prestige (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Prestige (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 Prestige (PPO) in 2025, please refer to our full plan details page.
Freedom Blue PPO Prestige (PPO) is a PPO plan offered by Highmark Health available for enrollment in 2025 to people living in Delaware. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Freedom Blue PPO 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 Blue PPO 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 Blue PPO Prestige (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.00. 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 $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
The Freedom Blue PPO Prestige (PPO) plan has an enhanced alternative drug benefit. This plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at a preferred pharmacy, while standard generic drugs have 25% coinsurance at both preferred and standard pharmacies. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Freedom Blue PPO Prestige (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital care, with varying copays for different services. Emergency services have a $110 copay, while ambulance services have a $250 copay. Primary care, preventive services, hearing exams, vision services, and dental services are also covered, with specific copays or coinsurance depending on the service. Additional benefits include coverage for home infusion, dialysis, medical equipment, and diagnostic services. The plan also provides coverage for skilled nursing facility stays and offers other services such as over-the-counter items and meal benefits. Note that some services like cardiac rehabilitation, additional hours of care, and certain other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. Inpatient Hospital-Acute has a $325 copay per admission or stay, and the Additional Days benefit has no copay. Inpatient Hospital Psychiatric has a $425 copay for days 1-3, and no copay for days 4-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $200 copay, and observation services, also with a $200 copay. Ambulatory Surgical Center (ASC) Services have a $155 copay, while individual and group sessions for Outpatient Substance Abuse have a copay between $30 and $30. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Freedom Blue PPO Prestige (PPO) plan.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Freedom Blue PPO Prestige (PPO) plan. Ground and air ambulance services have a $250 copay, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under the Freedom Blue PPO Prestige (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Worldwide Emergency Transportation has a $250 copay; there is no coinsurance for any of these services.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Occupational Therapy Services, Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services, and Opioid Treatment Program Services each have a $30 copay. Physical Therapy and Speech-Language Pathology Services have no copay or coinsurance. Additional Telehealth Benefits have a copay between $0 and $30.
Preventive Services See details
The Freedom Blue PPO Prestige (PPO) plan covers preventive services, including Medicare-covered services with no copay. Additional preventive services are covered, but some services like Health Education, Telemonitoring Services, and Counseling Services are not covered. Home and Bathroom Safety Devices and Modifications have a 20% coinsurance.
Hearing Services See details
Freedom Blue PPO Prestige (PPO) covers hearing exams, including routine hearing exams once per year, but does not cover fitting/evaluation for hearing aids. The plan covers prescription hearing aids with a maximum benefit of $500 per year, with a copay between $699 and $999 for prescription hearing aids, but does not cover OTC hearing aids, prescription hearing aids for the inner ear, outer ear, or over the ear.
Vision Services See details
The Freedom Blue PPO Prestige (PPO) plan covers vision services, including routine eye exams once per year, with no deductible. Eyewear is covered with a combined maximum benefit of $350 per year for both in-network and out-of-network services, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Freedom Blue PPO Prestige (PPO) plan covers dental services with a maximum benefit of $3,500 per year, including oral exams, dental x-rays, cleaning, and fluoride treatment. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with a 40% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance. Also covered are Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Prestige (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the Freedom Blue PPO Prestige (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit has a coinsurance for Medicare-covered Prosthetic Devices and Medical Supplies, and Medical Supplies has a 20% coinsurance. Diabetic Equipment has a coinsurance for Medicare-covered Diabetic Supplies and Therapeutic Shoes or Inserts, while Diabetic Supplies has between 0% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts has a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Freedom Blue PPO Prestige (PPO) plan. While all diagnostic and radiological services are covered, Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a maximum copay of $150, Therapeutic Radiological Services have a maximum copay of $60, and Outpatient X-Ray Services have a $10 copay.
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. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but this plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Freedom Blue PPO Prestige (PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $100 every three months, and Meal Benefits for chronic illness, but does not cover 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.
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