Freedom Blue PPO Valor (PPO) 2025 Plan Details for Lawrence County, Pennsylvania Residents
Freedom Blue PPO Valor (PPO) 2025 Plan Details for Lawrence County, Pennsylvania Residents
Choosing the right Medicare Advantage plan in Lawrence County is crucial for your healthcare needs in 2025. With Freedom Blue PPO Valor (PPO) as one of the options, you can compare it side-by-side with other available plans to find the best fit. Whether you prefer enrolling online or seeking advice from a licensed agent, we’ve made the process simple and straightforward.
Freedom Blue PPO Valor Overview
Plan ID H3916-042-1 Overview | |
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Health Plan ID: | H3916-042-1 |
Medicare Advantage Plan Type: | Local PPO |
Plan Year: | 2024 |
Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | $6,000 |
Part B Give Back: | $60.00/mo |
Part D Drug Plan Benefit: | Not Included |
Part D Gap Coverage: | No |
Supplemental Benefits: | Vision, Hearing |
Availability: | Lawrence County, PA |
Insured By: | Highmark Blue Cross Blue Shield or Highmark Blue Shield |
Explore Freedom Blue PPO Valor Benefits
Freedom Blue PPO Valor is a Medicare Advantage Preferred Provider Organization (PPO) plan that combines flexibility with comprehensive healthcare coverage. With a monthly premium of $0.00, this plan covers all the essential benefits of Medicare Part A and Part B, giving you access to vital medical services. As a PPO plan, Freedom Blue PPO Valor offers the freedom to visit any Medicare-approved provider, with lower costs when you use providers within the network.
Keep in mind that Freedom Blue PPO Valor does not include a Medicare prescription drug plan. If you need drug coverage, you can explore standalone Part D plans. Freedom Blue PPO Valor also provides financial protection with an annual maximum out-of-pocket (MOOP) limit of $6,000. Once you reach this limit, the plan covers 100% of your in-network healthcare costs for the remainder of the year. This makes Freedom Blue PPO Valor a solid option for those who value flexibility and financial security in their healthcare coverage.
We're Here to Help You Enroll |
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Out-of-Pocket Expenses
With Freedom Blue PPO Valor, you'll have cost-sharing expenses, which are the out-of-pocket costs for approved healthcare services. The table below provides a summary of the typical in-network out-of-pocket costs associated with plan H3916-042-1.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 |
Specialist: | $10 Copay |
Wellness & Preventive Programs: | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $10 Copay |
Routine Foot Care: | $10 Copay |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $15 Copay Prior Authorization Required |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | $100 Copay |
Urgent care: | $50 Copay |
Ground ambulance: | $250 Copay |
Inpatient hospital care: | $275.00 per stay |
Outpatient hospital care: | $195 Copay Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $203.00 per day for days 21 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $5 Copay |
Outpatient group therapy: | $5 Copay |
Inpatient psychiatric hospital care: | $325.00 per day for days 1 through 3 $0.00 per day for days 4 and beyond |
Outpatient group therapy: | $5 Copay |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $15 Copay Prior Authorization Required |
Occupational therapy: | $15 Copay Prior Authorization Required |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $225 Copay Prior Authorization Required |
Lab services: | $0 |
Outpatient x-rays: | $20 Copay Prior Authorization Required |
Diagnostic tests and procedures: | $0 |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Most preventive services are covered 100% by Freedom Blue PPO Valor as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that Highmark Blue Cross Blue Shield or Highmark Blue Shield offers with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | Not Covered |
Vision | Maximum vision benefit: | Non Specified |
Eyeglasses (frames and lenses) (In-Network) | Not Covered |
Routine eye exam (In-Network) | Covered Limits may apply |
Contact lenses (In-Network) | Covered Limits may apply |
Additional Benefits
None specified.
Part D Prescription Drug Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Rating Overview
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
CMS Measure | Star Rating |
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2024 Overall 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 |
Eligibility Requirements for Freedom Blue PPO Valor
You are eligible to enroll in Freedom Blue PPO Valor if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
- You do not have End-Stage Renal Disease (ESRD), with some exceptions.
If these criteria describe your situation, you’re eligible to sign up for Freedom Blue PPO Valor and take advantage of its full range of benefits.
When Should You Enroll in Freedom Blue PPO Valor?
Knowing when you can enroll in Freedom Blue PPO Valor is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) for expert guidance from a licensed insurance agent.
How to Enroll in Freedom Blue PPO Valor
Getting started with Freedom Blue PPO Valor is simple. Here are your options:
- Online Enrollment: Easily enroll online using a secure form. Visit the MedicareEnrollment.com enrollment page and follow the steps to complete your enrollment.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711). A licensed insurance agent will guide you through the process and answer any questions.
- Through Medicare.gov: Enroll through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the instructions to join a Medicare Advantage plan.
- Directly with the Plan: You can also enroll directly with Freedom Blue PPO Valor. The plan's contact information is available below in the "Contact" section.
Be sure to enroll during the appropriate period to ensure your coverage begins without delay.
Contact Highmark Blue Cross Blue Shield or Highmark Blue Shield
Website: | http://medicare.highmark.com |
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Formulary: | http://medicare.highmark.com |
Pharmacy: | Highmark Blue Cross Blue Shield or Highmark Blue Shield Pharmacy Page |
New Members: | (866)743-5478 |
TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, you can do so on the Social Security Administration website. For more information about the Medicare Part C program, visit the official Medicare website or call 1-800-MEDICARE.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
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