Highmark Blue Shield Freedom Valor (PPO)
H5526 - 024 - 0
(5 / 5)
Highmark Blue Shield Freedom Valor (PPO) is a Medicare Advantage Plan by Highmark BCBS of WNY and Highmark BS of NENY.
This page features plan details for 2023 Highmark Blue Shield Freedom Valor (PPO) H5526 – 024 – 0 available in Northeastern New York.
IMPORTANT: This page features the 2023 version of this plan. See the 2025 version using the link below:
No 2025 version found. You can use the location links below to find 2025 plans in your area.
Locations
Highmark Blue Shield Freedom Valor (PPO) is offered in the following locations.
Plan Overview
Highmark Blue Shield Freedom Valor (PPO) offers the following coverage and cost-sharing.
| Insurer: | Highmark BCBS of WNY and Highmark BS of NENY |
| Health Plan Deductible: | $0.00 |
| MOOP: | $10,000 In and Out-of-network $6,700 In-network |
| Drugs Covered: | No |
Ready to sign up for Highmark Blue Shield Freedom Valor (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
Medicare Part B Give Back Benefit
The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.
Highmark Blue Shield Freedom Valor (PPO) qualifies for a monthly Medicare Give Back Benefit of $50.00.
| Premium Reduction: | $50.00 |
Premium Breakdown
Highmark Blue Shield Freedom Valor (PPO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $164.90 | $0.00 | $50.00 | $ |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Highmark Blue Shield Freedom Valor (PPO) also provides the following benefits.
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
| In-Network: No |
Dental (comprehensive)
| Diagnostic services: | In-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
| Diagnostic services: | Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
| Endodontics: | In-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
| Endodontics: | Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
| Extractions: | In-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
| Extractions: | Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
| Non-routine services: | Not covered (no limits) |
| Periodontics: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Periodontics: | Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | Not covered (no limits) |
| Restorative services: | In-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
| Restorative services: | Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Dental (preventive)
| Cleaning: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Cleaning: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Dental x-ray(s): | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Dental x-ray(s): | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Fluoride treatment: | Not covered (no limits) |
| Oral exam: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Oral exam: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Diagnostic procedures/lab services/imaging
| Diagnostic radiology services (e.g., MRI): | In-Network: $150 copay (authorization required) (referral not required) |
| Diagnostic radiology services (e.g., MRI): | Out-of-Network: 50% coinsurance (authorization required) (referral not required) |
| Diagnostic tests and procedures: | In-Network: $45 copay (authorization required) (referral not required) |
| Diagnostic tests and procedures: | Out-of-Network: 50% coinsurance (authorization required) (referral not required) |
| Lab services: | In-Network: $0 copay (authorization required) (referral not required) |
| Lab services: | Out-of-Network: 50% coinsurance (authorization required) (referral not required) |
| Outpatient x-rays: | In-Network: $45 copay (authorization required) (referral not required) |
| Outpatient x-rays: | Out-of-Network: 50% coinsurance (authorization required) (referral not required) |
Doctor visits
| Primary: | In-Network: $0 copay |
| Primary: | Out-of-Network: 50% coinsurance per visit |
| Specialist: | In-Network: $35 copay per visit (authorization not required) (referral not required) |
| Specialist: | Out-of-Network: 50% coinsurance per visit (authorization not required) (referral not required) |
Emergency care/Urgent care
| Emergency: | $95 copay per visit (always covered) |
| Urgent care: | $60 copay per visit (always covered) |
Foot care (podiatry services)
| Foot exams and treatment: | In-Network: $35 copay (authorization not required) (referral not required) |
| Foot exams and treatment: | Out-of-Network: 50% coinsurance (authorization not required) (referral not required) |
| Routine foot care: | In-Network: $35 copay (limits may apply) (authorization not required) (referral not required) |
| Routine foot care: | Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Ground ambulance
| In-Network: $200 copay | |
| Out-of-Network: $200 copay |
Health plan deductible
| $0.00 |
Health plan deductibles (other)
| In-Network: No |
Hearing
| Fitting/evaluation: | In-Network: $0 copay (no limits) (authorization not required) (referral not required) |
| Fitting/evaluation: | Out-of-Network: $45 copay (no limits) (authorization not required) (referral not required) |
| Hearing aids: | In-Network: $699-999 copay (limits may apply) (authorization not required) (referral not required) |
| Hearing aids: | Out-of-Network: $699-999 copay (limits may apply) (authorization not required) (referral not required) |
| Hearing exam: | In-Network: $35 copay (authorization not required) (referral not required) |
| Hearing exam: | Out-of-Network: 50% coinsurance (authorization not required) (referral not required) |
Hospital coverage (inpatient)
| In-Network: $290 per day for days 1 through 7 $0 per day for days 8 through 90 (authorization required) (referral not required) | |
| Out-of-Network: 50% per stay (authorization required) (referral not required) |
Hospital coverage (outpatient)
| In-Network: $325 copay per visit (authorization required) (referral not required) | |
| Out-of-Network: 50% coinsurance per visit (authorization required) (referral not required) |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| $10,000 In and Out-of-network $6,700 In-network |
Medical equipment/supplies
| Diabetes supplies: | In-Network: $0 copay (authorization required) |
| Diabetes supplies: | Out-of-Network: 50% coinsurance per item (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen): | In-Network: 0-20% coinsurance per item (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen): | Out-of-Network: 50% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs): | In-Network: 20% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs): | Out-of-Network: 50% coinsurance per item (authorization required) |
Medicare Part B drugs
| Chemotherapy: | In-Network: 20% coinsurance (authorization required) |
| Chemotherapy: | Out-of-Network: 50% coinsurance (authorization required) |
| Other Part B drugs: | In-Network: 20% coinsurance (authorization required) |
| Other Part B drugs: | Out-of-Network: 50% coinsurance (authorization required) |
Mental health services
| Inpatient hospital – psychiatric: | In-Network: $260 per day for days 1 through 6 $0 per day for days 7 through 90 (authorization required) (referral not required) |
| Inpatient hospital – psychiatric: | Out-of-Network: 50% per stay (authorization required) (referral not required) |
| Outpatient group therapy visit: | In-Network: $40 copay (authorization not required) (referral not required) |
| Outpatient group therapy visit: | Out-of-Network: 50% coinsurance (authorization not required) (referral not required) |
| Outpatient group therapy visit with a psychiatrist: | In-Network: $40 copay (authorization not required) (referral not required) |
| Outpatient group therapy visit with a psychiatrist: | Out-of-Network: 50% coinsurance (authorization not required) (referral not required) |
| Outpatient individual therapy visit: | In-Network: $40 copay (authorization not required) (referral not required) |
| Outpatient individual therapy visit: | Out-of-Network: 50% coinsurance (authorization not required) (referral not required) |
| Outpatient individual therapy visit with a psychiatrist: | In-Network: $40 copay (authorization not required) (referral not required) |
| Outpatient individual therapy visit with a psychiatrist: | Out-of-Network: 50% coinsurance (authorization not required) (referral not required) |
Optional supplemental benefits
| No |
Preventive care
| In-Network: $0 copay (authorization required) (referral not required) | |
| Out-of-Network: 50% coinsurance (authorization required) (referral not required) |
Rehabilitation services
| Occupational therapy visit: | In-Network: $15 copay (authorization not required) (referral not required) |
| Occupational therapy visit: | Out-of-Network: 50% coinsurance (authorization not required) (referral not required) |
| Physical therapy and speech and language therapy visit: | In-Network: $15 copay (authorization not required) (referral not required) |
| Physical therapy and speech and language therapy visit: | Out-of-Network: 50% coinsurance (authorization not required) (referral not required) |
Skilled Nursing Facility
| In-Network: $0 per day for days 1 through 20 $196 per day for days 21 through 100 (authorization required) (referral not required) | |
| Out-of-Network: 50% per stay (authorization required) (referral not required) |
Transportation
| Not covered |
Vision
| Contact lenses: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Contact lenses: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglass frames: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglass frames: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglass lenses: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglass lenses: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglasses (frames and lenses): | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglasses (frames and lenses): | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Other: | Not covered (no limits) |
| Routine eye exam: | In-Network: $25 copay (limits may apply) (authorization not required) (referral not required) |
| Routine eye exam: | Out-of-Network: 20% coinsurance (limits may apply) (authorization not required) (referral not required) |
| Upgrades: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Upgrades: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Wellness programs (e.g., fitness, nursing hotline)
| Covered (authorization not required) (referral not required) |
Ready to sign up for Highmark Blue Shield Freedom Valor (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