Freedom Blue PPO Valor (PPO) H3916-042 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 Valor (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $6,000 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $6,000 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 Valor (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.

2023 Highmark Inc. Medicare Advantage Plan Overview

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

Freedom Blue PPO Valor (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 Valor (PPO) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Highmark Inc. charges a $0 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 Valor (PPO) by Highmark Inc. MOOP is $6,000. Once you spend $6,000 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 Valor (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

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Contact lenses

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

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Eyeglass frames

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

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Eyeglass lenses

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

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Eyeglasses (frames and lenses)

Vision	Not covered

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Other

Vision	Not covered

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Routine eye exam

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

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Upgrades

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

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

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Occupational therapy visit

In-Network Rehabilitation services	$15 copay
Out-of-Network Rehabilitation services	$35 copay

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Physical therapy and speech and language therapy visit

In-Network Rehabilitation services	$15 copay
Out-of-Network Rehabilitation services	$35 copay

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Cleaning

Out-of-Network Preventive dental	30% coinsurance
In-Network Preventive dental	$0 copay

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Dental x-ray(s)

Out-of-Network Preventive dental	30% coinsurance
In-Network Preventive dental	$0 copay

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Fluoride treatment

Preventive dental	Not covered

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Oral exam

Out-of-Network Preventive dental	30% coinsurance
In-Network Preventive dental	$0 copay

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Out-of-Network Preventive care	$0 copay
In-Network Preventive care	$0 copay
In-Network Outpatient hospital coverage	$245 copay per visit
Out-of-Network Outpatient hospital coverage	$375 copay per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

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Inpatient hospital - psychiatric

In-Network Mental health services	$325 per day for days 1 through 3 $0 per day for days 4 through 90
Out-of-Network Mental health services	$475 per day for days 1 through 3 $0 per day for days 4 through 90

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Outpatient group therapy visit

Out-of-Network Mental health services	$35 copay
In-Network Mental health services	$5 copay

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Outpatient group therapy visit with a psychiatrist

Out-of-Network Mental health services	$35 copay
In-Network Mental health services	$5 copay

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Outpatient individual therapy visit

In-Network Mental health services	$5 copay
Out-of-Network Mental health services	$35 copay

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Outpatient individual therapy visit with a psychiatrist

In-Network Mental health services	$5 copay
Out-of-Network Mental health services	$35 copay

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Chemotherapy

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

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Other Part B drugs

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

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Diabetes supplies

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

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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

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

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

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$8,950 In and Out-of-network $6,000 In-network
In-Network Inpatient hospital coverage	$275 per stay
Out-of-Network Inpatient hospital coverage	$395 per stay

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Fitting/evaluation

Hearing	Not covered

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Hearing aids

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

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Hearing exam

Out-of-Network Hearing	$10 copay
In-Network Hearing	$10 copay

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Health plan deductible	$0
In-Network Ground ambulance	$250 copay
Out-of-Network Ground ambulance	$250 copay or 30% coinsurance

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Foot exams and treatment

Out-of-Network Foot care (podiatry services)	$10 copay
In-Network Foot care (podiatry services)	$10 copay

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Routine foot care

In-Network Foot care (podiatry services)	$10 copay
Out-of-Network Foot care (podiatry services)	$10 copay

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Emergency

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

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Urgent care

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

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Primary

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

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Specialist

Out-of-Network Doctor visits	$10 copay per visit
In-Network Doctor visits	$10 copay per visit

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Diagnostic radiology services (e.g., MRI)

Out-of-Network Diagnostic procedures/lab services/imaging	$325 copay
In-Network Diagnostic procedures/lab services/imaging	$225 copay

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Diagnostic tests and procedures

Out-of-Network Diagnostic procedures/lab services/imaging	$35 copay
In-Network Diagnostic procedures/lab services/imaging	$0 copay

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Lab services

In-Network Diagnostic procedures/lab services/imaging	$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$35 copay

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Outpatient x-rays

In-Network Diagnostic procedures/lab services/imaging	$20 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$35 copay

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Diagnostic services

Comprehensive dental	Not covered

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Endodontics

Out-of-Network Comprehensive dental	50% coinsurance
In-Network Comprehensive dental	50% coinsurance

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Extractions

In-Network Comprehensive dental	50% coinsurance
Out-of-Network Comprehensive dental	50% coinsurance

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Non-routine services

Comprehensive dental	Not covered

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Periodontics

Comprehensive dental	Not covered

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Prosthodontics, other oral/maxillofacial surgery, other services

Out-of-Network Comprehensive dental	50% coinsurance
In-Network Comprehensive dental	50% coinsurance

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Restorative services

Out-of-Network Comprehensive dental	50% coinsurance
In-Network Comprehensive dental	50% coinsurance

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

Freedom Blue PPO Valor (PPO) Reviews

Is Freedom Blue PPO Valor (PPO) a good plan? Freedom Blue PPO Valor (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 Valor Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H3916-042 Health Plan

Member Complaints and Changes in Plans Performance

Health Plan Customer Service Rating for Highmark Inc.

Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

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 Valor (PPO) requires you to live in that plan’s service area. The service area is listed below:

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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.