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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 2026, 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 2026.
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 robust coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, home health services, and partial hospitalization. Specialist visits require a low $10 copay, while emergency room care is covered with a $130 copay that is waived if you are admitted. Inpatient hospital stays feature a flat $275 copay per stay with no coinsurance, and outpatient hospital services carry a $245 copay. For everyday wellness, the plan includes preventive dental care with no copay and comprehensive dental coverage up to a $3,000 annual maximum with 40% coinsurance. Vision and hearing benefits feature low $10 copays for routine exams, alongside a $400 eyewear allowance and prescription hearing aid coverage. Members also benefit from a $100 quarterly allowance for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Freedom Blue PPO Valor (PPO) covers inpatient acute hospital stays with a $275 copay per stay, unlimited additional days, and no coinsurance, subject to prior authorization. Inpatient psychiatric care requires prior authorization and has no coinsurance, costing a $325 daily copay for days 1 through 3 and no copay for days 4 through 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Freedom Blue PPO Valor (PPO) covers outpatient hospital and daily observation services for a $245 copay, and ambulatory surgical center services for a $195 copay, both with no coinsurance. Outpatient substance abuse services require a $5 copay per individual or group session with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Freedom Blue PPO Valor (PPO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Freedom Blue PPO Valor (PPO) covers ground and air ambulance services with a $425 copay and no coinsurance, which is not waived upon hospital admission. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Freedom Blue PPO Valor (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within three days, and urgently needed services with a $40 copay, with no coinsurance for either service. Worldwide emergency services are also covered with no coinsurance, featuring a $130 copay for emergency care, a $40 copay for urgent care, and a $425 copay for emergency transportation.
Primary Care See details
Freedom Blue PPO Valor (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $10 copay and no coinsurance. Most other services, including therapy, mental health, podiatry, and telehealth, feature copays ranging from $0 to $40 and no coinsurance. Chiropractic care is only partially covered under this plan because other chiropractic services are not covered.
Preventive Services See details
Freedom Blue PPO Valor (PPO) partially covers preventive services, offering annual physical exams, kidney disease education, and standard screenings with no copay and no coinsurance. While select benefits like remote access technologies (up to a $10 copay) and home safety devices (20% coinsurance) are covered, many options—including health education, personal emergency response systems, and nutritional therapy—are not covered.
Hearing Services See details
Freedom Blue PPO Valor (PPO) provides partially covered hearing services, which include one routine hearing exam per year for a $10 copay and no coinsurance, though fitting and evaluation exams are not covered. Prescription hearing aids are covered with a copay ranging from $699 to $999 and no coinsurance up to a $500 annual maximum, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Freedom Blue PPO Valor (PPO) offers partially covered vision services, featuring one routine eye exam per year for a $10 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $400 annual combined maximum for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Freedom Blue PPO Valor (PPO) provides partially covered dental services up to a $3,000 annual maximum, featuring a $10 copay and no coinsurance for Medicare dental services, no copay and no coinsurance for preventive care, and no copay with 40% coinsurance for comprehensive care. Other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Freedom Blue PPO Valor (PPO) covers home infusion bundled services with no copay, with prior authorization required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while covered insulin requires a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Freedom Blue PPO Valor (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Freedom Blue PPO Valor (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and prior authorization required. Coinsurance ranges from 0% to 50% for durable medical equipment, 20% for prosthetics and medical supplies, and 0% to 20% for diabetic equipment.
Diagnostic and Radiological Services See details
Freedom Blue PPO Valor (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic tests have a copay of $0 to $10, outpatient x-rays carry a $20 copay, and therapeutic and diagnostic radiological services require minimum copays of $60 and $225, respectively.
Home Health Services See details
Freedom Blue PPO Valor (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Freedom Blue PPO Valor (PPO) plan. This exclusion applies to all related sub-services, including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Freedom Blue PPO Valor (PPO) with no coinsurance, as additional days beyond the Medicare-covered limit are not covered. The plan features no copay for days 1 through 20, a daily copay of $218 for days 21 through 100, and does not require a prior three-day hospital stay before admission.
Other Services See details
Freedom Blue PPO Valor (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $100 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this plan.
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