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Freedom Blue PPO Valor (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Freedom Blue PPO Valor (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 Valor (PPO) in 2025, please refer to our full plan details page.
Freedom Blue PPO Valor (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 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 Blue PPO 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 Blue PPO 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 $70.00. 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 $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
Prescription drugs are not covered by Freedom Blue PPO Valor (PPO).
Additional Benefits
The Freedom Blue PPO Valor (PPO) plan offers a range of benefits with varying cost structures. Inpatient hospital stays have a copay, while outpatient services, including emergency and primary care, generally have copays as well. Preventive services, home health services, and skilled nursing facilities have no copay for the first 20 days. The plan also covers vision, dental, and hearing services, with copays and annual maximums. Medical equipment, dialysis, and home infusion services are covered with coinsurance. However, some services like cardiac rehabilitation and some diagnostic and radiological services 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 $275 copay per admission, and there is no copay for additional days. For Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-3, and no copay for days 4-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services and Observation Services have a $245 copay, Ambulatory Surgical Center (ASC) Services have a $195 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a $5 copay.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the Freedom Blue PPO Valor (PPO) plan. The plan covers the costs associated with this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Freedom Blue PPO Valor (PPO) plan. Ground and Air Ambulance Services have a $260 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. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a $50 copay and no coinsurance, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $260 copay, with no coinsurance for any of these services.
Primary Care See details
The Freedom Blue PPO 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 $10 copay, mental health specialty services with a $5 copay for individual and group sessions, podiatry services with a $10 copay, other health care professional services with a copay between $0 and $10, 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 $50, and opioid treatment program services with a $5 copay. Routine chiropractic care is limited to 8 visits per year.
Preventive Services See details
Preventive services include Medicare-covered services with no copay, annual physical exams, additional preventive services, kidney disease education services, and other preventive services. Additional preventive services include coverage for home and bathroom safety devices and modifications with 20% coinsurance, and remote access technologies with a copay between $0 and $10. Other services like health education, counseling, and telemonitoring services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $10 copay, and Routine Hearing Exams are covered once per year. Prescription hearing aids are covered up to $500 per year with a copay between $699 and $999. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $10 copay, and eyewear with a combined maximum benefit of $400 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services include Medicare Dental Services with a $10 copay, and other dental services with a $3,000 maximum benefit per year. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment are covered, with the number of visits limited. Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with a 40% coinsurance. However, 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 coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Freedom Blue PPO Valor (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance with no copay, and Diabetic Supplies have a 0-20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Freedom Blue PPO Valor (PPO) plan. Diagnostic Procedures/Tests and Lab Services are not covered, while Diagnostic Radiological Services have a maximum copay of $225, Therapeutic Radiological Services have a maximum copay of $60, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Freedom Blue PPO 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 Blue PPO Valor (PPO) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Freedom Blue PPO Valor (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are covered, but acupuncture, meal benefits, 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. This plan offers an over-the-counter (OTC) items benefit with a maximum coverage amount of $100 every three months.
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