2023 Freedom Blue PPO Basic (PPO)

Freedom Blue PPO Basic (PPO) H3916-012 is a 2023 Medicare Advantage Plan or Part-C by Highmark Inc. available to residents in Pennsylvania. This plan does not provide extra prescription drug (Part-D) coverage. Highmark Inc. Freedom Blue PPO Basic (PPO) has a monthly premium of $62.00 and has an in-network maximum out-of-pocket limit of $5,900 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $5,900 out-of-pocket. This can be an extremely nice safety net.

Highmark Inc. works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Freedom Blue PPO Basic (PPO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Highmark Inc. and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Highmark Inc. except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Pennsylvania.

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Benefits
Monthly Costs
MOOP
Reviews
Coverage Area

2023 Highmark Inc. Medicare Advantage Plan Overview

Name:	Freedom Blue PPO Basic (PPO)
Plan ID:	H3916 012 0
Provider:	Highmark Inc.
Year:	2023
Type:	Local PPO *
Combined Premium (C+D):	$62.00/mo
MOOP:	$5,900/yr
Similar Plan:	H3916-015

What type of plan is Freedom Blue PPO Basic (PPO)

Freedom Blue PPO Basic (PPO) is a Local PPO *. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network, but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

How much does Freedom Blue PPO Basic (PPO) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Highmark Inc. charges a $62.00 premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Freedom Blue PPO Basic (PPO) by Highmark Inc. MOOP is $5,900. Once you spend $5,900 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.

2023 Summary of Benefits

The benefit information provided is a summary of what Freedom Blue PPO Basic (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Highmark Inc. helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)	Covered

Contact lenses

Out-of-Network Vision	$0 copay
In-Network Vision	$0 copay

Eyeglass frames

Out-of-Network Vision	$0 copay
In-Network Vision	$0 copay

Eyeglass lenses

In-Network Vision	$0 copay
Out-of-Network Vision	$0 copay

Eyeglasses (frames and lenses)

Vision	Not covered

Other

Vision	Not covered

Routine eye exam

In-Network Vision	$0 copay
Out-of-Network Vision	$50 copay

Upgrades

In-Network Vision	$0 copay
Out-of-Network Vision	$0 copay

In-Network Transportation	$0 copay
Out-of-Network Transportation	30% coinsurance
Out-of-Network Skilled Nursing Facility	30% per stay
In-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $196 per day for days 21 through 100

Occupational therapy visit

Out-of-Network Rehabilitation services	$35 copay
In-Network Rehabilitation services	$35 copay

Physical therapy and speech and language therapy visit

In-Network Rehabilitation services	$35 copay
Out-of-Network Rehabilitation services	$35 copay

Cleaning

Preventive dental	Covered under office visit

Dental x-ray(s)

In-Network Preventive dental	$15 copay
Out-of-Network Preventive dental	30% coinsurance

Fluoride treatment

Preventive dental	Not covered

Office visit

In-Network Preventive dental	$15.00
Out-of-Network Preventive dental	30% coinsurance

Oral exam

Preventive dental	Covered under office visit

In-Network Preventive care	$0 copay
Out-of-Network Preventive care	$0 copay
In-Network Outpatient hospital coverage	$200 copay per visit
Out-of-Network Outpatient hospital coverage	$200 copay per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

Inpatient hospital - psychiatric

Out-of-Network Mental health services	$340 per stay
In-Network Mental health services	$340 per stay

Outpatient group therapy visit

In-Network Mental health services	$35 copay
Out-of-Network Mental health services	$35 copay

Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	$35 copay
Out-of-Network Mental health services	$35 copay

Outpatient individual therapy visit

Out-of-Network Mental health services	$35 copay
In-Network Mental health services	$35 copay

Outpatient individual therapy visit with a psychiatrist

In-Network Mental health services	$35 copay
Out-of-Network Mental health services	$35 copay

Chemotherapy

Out-of-Network Medicare Part B drugs	30% coinsurance
In-Network Medicare Part B drugs	20% coinsurance

Other Part B drugs

Out-of-Network Medicare Part B drugs	30% coinsurance
In-Network Medicare Part B drugs	20% coinsurance

Diabetes supplies

In-Network Medical equipment/supplies	0-20% coinsurance per item
Out-of-Network Medical equipment/supplies	30% coinsurance per item

Durable medical equipment (e.g., wheelchairs, oxygen)

In-Network Medical equipment/supplies	20% coinsurance per item
Out-of-Network Medical equipment/supplies	30% coinsurance per item

Prosthetics (e.g., braces, artificial limbs)

Out-of-Network Medical equipment/supplies	30% coinsurance per item
In-Network Medical equipment/supplies	20% coinsurance per item

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$8,950 In and Out-of-network $5,900 In-network
In-Network Inpatient hospital coverage	$340 per stay
Out-of-Network Inpatient hospital coverage	$340 per stay

Fitting/evaluation

Hearing	Not covered

Hearing aids

Out-of-Network Hearing	$0 copay
In-Network Hearing	$699-999 copay

Hearing exam

Out-of-Network Hearing	$35 copay
In-Network Hearing	$35 copay

Health plan deductible	$0
In-Network Ground ambulance	$125 copay
Out-of-Network Ground ambulance	$125 copay or 30% coinsurance

Foot exams and treatment

Out-of-Network Foot care (podiatry services)	$35 copay
In-Network Foot care (podiatry services)	$35 copay

Routine foot care

In-Network Foot care (podiatry services)	$35 copay
Out-of-Network Foot care (podiatry services)	$35 copay

Emergency

Emergency care/Urgent care	$95 copay per visit (always covered)

Urgent care

Emergency care/Urgent care	$50 copay per visit (always covered)

Primary

In-Network Doctor visits	$0 copay
Out-of-Network Doctor visits	$0 copay

Specialist

Out-of-Network Doctor visits	$35 copay per visit
In-Network Doctor visits	$35 copay per visit

Diagnostic radiology services (e.g., MRI)

Out-of-Network Diagnostic procedures/lab services/imaging	$150 copay
In-Network Diagnostic procedures/lab services/imaging	$150 copay

Diagnostic tests and procedures

In-Network Diagnostic procedures/lab services/imaging	$0-20 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$20 copay

Lab services

In-Network Diagnostic procedures/lab services/imaging	$0-20 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$20 copay

Outpatient x-rays

Out-of-Network Diagnostic procedures/lab services/imaging	$25 copay
In-Network Diagnostic procedures/lab services/imaging	$25 copay

Diagnostic services

Comprehensive dental	Not covered

Endodontics

Comprehensive dental	Not covered

Extractions

Comprehensive dental	Not covered

Non-routine services

Comprehensive dental	Not covered

Periodontics

Comprehensive dental	Not covered

Prosthodontics, other oral/maxillofacial surgery, other services

Comprehensive dental	Not covered

Restorative services

Comprehensive dental	Not covered

In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	No

Freedom Blue PPO Basic (PPO) Reviews

Is Freedom Blue PPO Basic (PPO) a good plan? Freedom Blue PPO Basic (PPO) received a 5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare Freedom Blue PPO Basic Reviews among several different plans.

2022 Overall Rating
Part C Summary Rating
Part-D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with H3916-012 Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement

Health Plan Customer Service Rating for Highmark Inc.

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Freedom Blue PPO Basic (PPO) requires you to live in that plan’s service area. The service area is listed below:

State:

Pennsylvania Medicare

County:

Adams County MA Plans

Berks County MA Plans

Bradford County MA Plans

Carbon County MA Plans

Centre County MA Plans

Clinton County MA Plans

Columbia County MA Plans

Cumberland County MA Plans

Dauphin County MA Plans

Franklin County MA Plans

Fulton County MA Plans

Juniata County MA Plans

Lackawanna County MA Plans

Lancaster County MA Plans

Lebanon County MA Plans

Lehigh County MA Plans

Luzerne County MA Plans

Lycoming County MA Plans

Mifflin County MA Plans

Monroe County MA Plans

Montour County MA Plans

Northampton County MA Plans

Northumberland County MA Plans

Perry County MA Plans

Pike County MA Plans

Schuylkill County MA Plans

Snyder County MA Plans

Sullivan County MA Plans

Susquehanna County MA Plans

Tioga County MA Plans

Union County MA Plans

Wayne County MA Plans

Wyoming County MA Plans

York County MA Plans

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How much does Freedom Blue PPO Basic (PPO) cost?

Highmark Inc. charges a $62.00 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Freedom Blue PPO Basic (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Freedom Blue PPO Basic (PPO) by Highmark Inc. MOOP is $5,900. Once you spend $5,900 you will pay nothing for Part A or Part B covered services.

What type of plan is Freedom Blue PPO Basic (PPO)?

Freedom Blue PPO Basic (PPO) is a Local PPO *. A (PPO) is a Medicare plan that has contracts with a network of preferred providers. You do not need to select a primary care physician and you do not need referrals to see other providers in the network.

Is Freedom Blue PPO Basic (PPO) a good plan?

Freedom Blue PPO Basic (PPO) received a 5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.

Source:CMS. Data as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.