Highmark Freedom Blue PPO

If you’re exploring Medicare Advantage plans, Highmark Freedom Blue PPO offers a mix of comprehensive coverage and flexibility.

You might be wondering about its benefits, costs, and services. Our article breaks down everything from essential coverage details to managing prescriptions and navigating plan costs. Discover if Highmark Freedom Blue PPO is your pathway to worry-free health care.


Key Takeaways


  • The plan covers a wide range of preventive services and screenings, offers a comprehensive prescription benefit package, and has strategies in place to manage prescription costs.


  • Members benefit from various perks like wellness programs with rewards, telehealth services, and a suite of support tools to manage healthcare needs, plus the plan strives to keep out-of-pocket costs predictable.

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Understanding Highmark Freedom Blue PPO

Highmark Freedom Blue PPO, a legacy product of Blue Cross and Blue Shield since the 1930s, provides extensive coverage as a Medicare Advantage Preferred-Provider Organization (PPO). It’s like the superhero version of Original Medicare, going above and beyond to provide coverage for:


  • Health
  • Prescription drugs
  • Dental
  • Vision
  • Hearing
  • Preventive care


This plan prioritizes your choice, allowing you to select your healthcare provider, whether within or outside the network, particularly when travelling.


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What Is Highmark Freedom Blue PPO?

Highmark Freedom Blue PPO offers:


  • A flexible and personalized healthcare experience
  • The liberty to choose where you get your care
  • Comprehensive coverage, both within and outside the network


Its utility is particularly noted while travelling, as it ensures your health is taken care of, wherever you might be.


The Connection with Medicare Advantage

So, how does Highmark Freedom Blue PPO fit into the Medicare Advantage picture? Think of it as a more enhanced version of Original Medicare. While Original Medicare covers hospital and nursing services and doctor visits, Medicare Advantage plans like Highmark Freedom Blue PPO go the extra mile by covering prescription drugs and additional benefits such as dental and vision care.

Qualifying for a Highmark Freedom Blue PPO plan requires you to have Medicare Part A benefits and enrollment in Part B. The plan offers a unique option with affordable premiums and predictable out-of-pocket costs, providing extensive coverage including health, prescription drugs, and routine dental needs.


Key Features of Freedom Blue PPO Plans


Highmark freedom blue ppo summary of benefits


Designed to cater to your needs, Highmark Freedom Blue PPO plans boast key features such as network flexibility that lets you choose your healthcare provider within the Freedom Blue PPO network and the combined Blue Plan Medicare.

These plans offer a comprehensive package, covering everything from doctor visits and hospital stays to outpatient services, emergency care, and preventive care.

Plus, they go a step further by covering health services, prescription drugs, and routine dental care, which is more than what many other Medicare Advantage plans provide.

They even help with preventive healthcare by covering health screenings and regular dental care, which are essential for maintaining good health.

Coverage Details: What You Need to Know

Having understood the key features of Highmark Freedom Blue PPO, we now examine the specifics of the coverage details. From preventive services and screenings to emergency care and specialized treatments, Highmark Freedom Blue PPO has its members covered.


Preventive Services and Screenings

Preventive services and screenings are all about catching health problems early before they become severe. Highmark Freedom Blue PPO covers a wide range of these services and screenings such as:


  • Abdominal aortic aneurysm screening
  • Alcohol misuse counseling
  • Bone mass measurement
  • Various cancer screenings

among others.


Highmark freedom blue ppo dental coverage



From mammograms for breast cancer screening, behavioral therapy for cardiovascular disease, to cervical and vaginal cancer screening, Highmark Freedom Blue PPO provides coverage.


Emergency Care and Urgent Services

Given the unpredictability of health emergencies, a plan covering emergency care and urgent services becomes indispensable. Highmark Freedom Blue PPO stands out by covering:


  • Emergency services, even when you’re traveling outside the U.S.
  • Urgent care, which is medical help for non-life-threatening issues that need quick attention.
  • Ambulance services, both emergency and non-emergency situations are covered under the plan.


Specialized Treatment Coverage

Highmark Freedom Blue PPO extends its coverage to provide for specialized treatments. The plan includes coverage for:


  • Specialist visits
  • Mental health services
  • Physical therapy
  • Chronic disease management, including management programs and nutritional counseling


However, it’s important to note that there may be some limitations to the coverage of these specialized treatments.

Prescription Benefits in Focus

Despite prescription drugs potentially being a significant expense, Highmark Freedom Blue PPO provides a safety net.


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The plan offers a broad range of prescription benefits, including a comprehensive formulary, coverage for both generic and brand-name drugs, and strategies to manage prescription costs.


Understanding the Formulary

Like any health plan, Highmark Freedom Blue PPO also places significant importance on the formulary. It’s essentially a list of prescription drugs that the plan covers. The formulary is arranged into a tier system, with different tiers for:


  • Generic drugs
  • Preferred brand drugs
  • Non-preferred brand drugs
  • Specialty drugs


The formulary is continuously updated to keep up with medical practices and drug availability, ensuring that you always have the most current information. And if your doctor prescribes a medication that’s not on the formulary, there’s a process in place for requesting an exception.


Generic vs. Brand-Name Prescriptions

Understanding the difference between generic and brand-name drugs becomes essential when dealing with prescriptions. While generic drugs have the same active ingredients as brand-name drugs, they often have different inactive ingredients and are generally cheaper.

Highmark Freedom Blue PPO covers both generic and brand-name drugs, giving you the freedom to choose based on your preferences and budget.

And while generic drugs usually cost less, the plan provides coverage for both, ensuring that you always have options.


Managing Prescription Costs

Highmark Freedom Blue PPO acknowledges the challenges of managing prescription costs. That’s why it offers several strategies to help you manage these costs.

From Extra Help from Medicare for those who qualify to a collaboration with Free Market Health 3 for instant authorization for specialty drugs, Highmark Freedom Blue PPO is committed to making prescriptions more affordable.

The plan even offers a mail-order pharmacy service, which could save you some money.

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Navigating Costs with Highmark Freedom Blue PPO

A thorough understanding of the costs associated with a health plan is a key factor in making an informed decision. With Highmark Freedom Blue PPO, you’ll find a range of cost components, including:


  • Premiums
  • Deductibles
  • Co-pays
  • Out-of-pocket maximums


Premiums and Deductibles Explained

Any health plan’s key cost components include premiums and deductibles. Premiums are the regular payments you make to keep your insurance coverage active, and for Highmark Freedom Blue PPO plans, the average premiums for 2022 are around $65.00 for the Freedom Blue PPO Basic and $27 for the Complete Blue PPO Distinct.

Deductibles, on the other hand, are the amount you have to pay out-of-pocket each year before your insurance starts to cover your healthcare costs.


Co-pays and Coinsurance

Your health plan also involves cost-sharing aspects such as co-pays and coinsurance. Co-pays are a set amount you pay for specific medical services, while coinsurance is a percentage of the costs you share with your health plan.

For example, under Highmark Freedom Blue PPO, you’ll have a $15 co-pay for in-network office visits, and a 30% coinsurance for out-of-network services after the deductible is met.

The co-pay also covers in-network dental services and routine eyeglass lenses. The coinsurance rates depend on the specifics of the plan’s coverage.


Out-of-Pocket Maximums

The out-of-pocket maximum acts as a safety net by limiting your annual healthcare expenses. This limit includes your deductibles, coinsurance, and co-pays, ensuring that you don’t have to bear an excessive financial burden in a particular year.

Under Highmark Freedom Blue PPO, the out-of-pocket maximums are $475 copay per admit for both in-network and out-of-network services. This limit helps you to budget your yearly healthcare expenses and provides financial protection against unexpected health issues.

Additional Perks and Support Services

Highmark Freedom Blue PPO not only provides comprehensive coverage but also offers additional perks and support services for its members. From wellness programs and rewards to telehealth options and extensive member support, Highmark Freedom Blue PPO strives to provide a well-rounded healthcare experience.


Wellness Programs and Rewards

Highmark Freedom Blue PPO encourages its members to lead a healthy lifestyle through its wellness programs.


Highmark freedom blue ppo provider portal



The plan’s Personalized Wellness Plan offers a variety of activities tailored to each individual’s health needs. What’s more? Members are automatically enrolled in these activities, making the journey to wellness seamless.

And the cherry on top? Members can earn cash rewards by participating in these activities.


Telehealth and Virtual Visits

In this digital age, healthcare has become easily accessible, just a click away. With Highmark Freedom Blue PPO, members can access telehealth services, allowing them to consult healthcare providers virtually, from the comfort of their homes.

And yes, this includes a range of healthcare services, from managing medications for chronic conditions to annual wellness visits and regular virtual visits with healthcare providers.

All doctors in the network can provide telehealth services, ensuring that you always have access to medical advice, no matter where you are.


Member Support and Resources

Highmark Freedom Blue PPO takes pride in offering its members extensive support. Members can easily access various resources to manage their healthcare needs, including:


  • A dedicated phone line for customer service
  • Online tools like a digital ID card
  • A ‘Find a Doctor’ feature
  • A coverage check tool



Highmark freedom blue ppo provider phone number



The plan also offers health management tools and resources like care management programs to help members stay in top shape.

Making an Informed Decision: Is Highmark Freedom Blue PPO Right for You?

Armed with all this information, the pressing question is – Does Highmark Freedom Blue PPO suit your needs? To answer this, it’s essential to evaluate your healthcare needs, compare the Highmark Freedom Blue PPO with other plans, and understand the enrollment periods and eligibility requirements.


Assessing Your Healthcare Needs

When it comes to healthcare, one size doesn’t fit all. Each individual has unique healthcare needs, and it’s important to assess these needs to determine if Highmark Freedom Blue PPO is a suitable option. Here are some factors to consider:


  • Your health status
  • Your age
  • Your cognitive ability
  • The healthcare resources available to you


Taking stock of these factors can help you make an informed decision.

You can also check the coverage details provided by Highmark for various healthcare services, including prescription drugs, to ensure it aligns with your health conditions. And remember, your healthcare needs can also be influenced by how frequently you need to visit the doctor.


Comparing Plans and Options

The decision to choose a healthcare plan is significant, and requires careful consideration of your options.

With Highmark Freedom Blue PPO, you have a plan that offers extensive coverage for health, prescription drugs, and routine dental care. But how does it compare to other Medicare Advantage or Medigap plans? Consider not just the coverage, but also the premiums, out-of-pocket costs, and plan ratings to determine which plan offers the best value for you.


Enrollment Periods and Eligibility

Understanding the enrollment periods and eligibility requirements is a prerequisite to benefit from the Highmark Freedom Blue PPO. As long as you have Medicare Part A benefits and are enrolled in Part B, you can sign up for Highmark Freedom Blue PPO plans.

You can enroll during the Initial Enrollment Period (IEP) or during certain Special Enrollment Periods depending on qualifying life events. Note that the enrollment periods might vary for people with specific circumstances.


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Navigating the world of health insurance can be daunting, but with the right information, you can make an informed decision. Highmark Freedom Blue PPO offers comprehensive coverage, flexibility, and a host of additional perks and support services.

From preventive services and specialized treatments to prescription benefits and cost management strategies, Highmark Freedom Blue PPO ensures that you are well-covered.

With options to manage healthcare virtually through telehealth services and a dedicated member support system, Highmark Freedom Blue PPO stands out as a comprehensive healthcare plan. So, go ahead, take charge of your health, and make an informed decision that suits your healthcare needs best!

Frequently Asked Questions



What type of insurance is Freedom Blue?

Freedom Blue is a Medicare Advantage Preferred Provider Organization (PPO) plan that provides coverage for various healthcare needs, including health, prescription drugs, dental, vision, hearing, and preventive care. You have the flexibility to receive care from doctors and hospitals of your choice, both in and out of the network, without needing referrals.


Is Highmark PPO Blue a Medicare plan?

Yes, Highmark PPO Blue is a Medicare plan with a contract, but enrollment depends on contract renewal.


What is the prefix for Freedom Blue PPO?

For Freedom Blue PPO, the alpha prefix is HKS or FEM for Plan Code 363 and HKR or FER for Plan Code 378.


How is Highmark Freedom Blue PPO different from Original Medicare?

Highmark Freedom Blue PPO offers more benefits than Original Medicare, such as coverage for prescription drugs, dental, and vision care. It’s a part of Medicare Advantage, giving you extra coverage beyond what Original Medicare provides.


What are the coverage details for Highmark Freedom Blue PPO?

Highmark Freedom Blue PPO offers coverage for preventive services, screenings, emergency care, and specialized treatments.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.