Freedom Blue PPO Standard (PPO)

H5106 - 034 - 2
Plan Not Rated

Freedom Blue PPO Standard (PPO) is a Medicare Advantage Plan by Highmark Blue Cross Blue Shield.

This page features plan details for 2026 Freedom Blue PPO Standard (PPO) H5106 – 034 – 2.

IMPORTANT: This page has been updated with plan and premium data for 2026. Enrollment for 2026 plans starts Oct 15, 2025.

Locations

Freedom Blue PPO Standard (PPO) is offered in the following locations.

Plan Overview

Freedom Blue PPO Standard (PPO) offers the following coverage and cost-sharing.

Insurer:Highmark Blue Cross Blue Shield
Health Plan Deductible:
MOOP:$6,500.00
Drugs Covered:Yes

Ready to sign up for Freedom Blue PPO Standard (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

Freedom Blue PPO Standard (PPO) has a monthly premium of $154.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$206.50 $88.80 $65.20 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Freedom Blue PPO Standard (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2100.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$65.20$32.50

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2100.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2100.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Ready to sign up for Freedom Blue PPO Standard (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

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