Plan H5106-032-1: Freedom Blue PPO Prestige (PPO) – 2025 Coverage Details
This page provides coverage, cost, and availability details for Highmark Blue Cross Blue Shield’s H5106-032-1 Medicare Advantage plan for 2025.
*CMS rated this Highmark Blue Cross Blue Shield plan (H5106-032-1) 4.5 (Good+) out of 5 stars.
Freedom Blue PPO Prestige Basic Plan Details
- Plan ID
- H5106-032-1
- Plan Type
- PPO
- Plan Year
- 2025
- Premium
- $29.00/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 5,300.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Enhanced, $0.00 deductible
- Supplemental Benefits
- Vision, Hearing
- Availability
- See List
- Insured By
- Highmark Blue Cross Blue Shield
| Summary of Benefits |
|---|
Health Plan Out-of-Pocket Costs
This Highmark Blue Cross Blue Shield Part C plan has cost-sharing. These are costs you pay out-of-pocket when you use approved health services. The following table summarizes the most common in-network out-of-pocket costs in plan H5106-032-1.
NOTE: Certain preventive services are covered 100% by the plan as a Part B benefit.
Doctor's Office Visits
- Primary
- Not Covered
- Specialist
- Not Covered
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $125 Copay
- Urgent care
- $35 Copay
- Ground ambulance
- $315 Copay
- Inpatient hospital care
- $325.00 per stay
- Skilled Nursing Facility
- $0.00 per day for days 1 through 20
$214.00 per day for days 21 and beyond
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- Not Covered
- Routine Foot Care
- Not Covered
Chiropractic Care
- Medicare-covered chiropractic
- $20 Copay
Prior Authorization Required - Routine chiropractic
- Not Covered
Mental Health Services
- Outpatient individual therapy
- $40 Copay
- Outpatient group therapy
- $40 Copay
- Inpatient psychiatric hospital care
- $425.00 per day for days 1 through 3
$0.00 per day for days 4 and beyond
Rehabilitation Services
- Physical therapy and speech and language therapy
- $20 Copay
Prior Authorization Required - Occupational therapy
- $20 Copay
Prior Authorization Required
Medical Equipment and Supplies
- Diabetes supplies
- 20% Coinsurance
Prior Authorization Required - Durable medical equipment
- 20% Coinsurance
Prior Authorization Required - Prosthetics
- 20% Coinsurance
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- $150 Copay
Prior Authorization Required - Lab services
- Not Covered
- Outpatient x-rays
- $15 Copay
Prior Authorization Required - Diagnostic tests and procedures
- Not Covered
Medicare Part B Drugs
- Chemotherapy
- 20% Coinsurance
- Other Part B drugs (Medicare-covered)
- 20% Coinsurance
Dental Services
- Medicare Covered Preventive Dental
- Not Covered
- Oral exam
- $0
- Dental x-rays
- $0
- Cleaning
- $0
- Periodontics
- Not Covered
- Endodontics
- Not Covered
- Restorative Services
- Not Covered
- Maximum dental benefit
- $3,500.00 (Every year)
Hearing Aids and Services
- Fitting/evaluation
- Covered
Limits may apply - Hearing aids
- Not Covered
- Hearing exam
- Not Covered
Vision Services
- Medicare-covered eye exam
- Routine eye exam
- Covered
Limits may apply - Eyewear benefits
- None
Get a copy of the Freedom Blue PPO Prestige Summary of Benefits.
Prescription Drug Costs & Benefits
Freedom Blue PPO Prestige includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.
As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.
Prescription Drug Premium with Extra Help
Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| Low Income Premium Subsidy CMS Pays: | $5.80 |
| Low Income Subsidy Premium: | $23.20 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Deductible
The Medicare Part D annual deductible with this plan is $0.00. You must pay this amount at the pharmacy before Highmark Blue Cross Blue Shield begins paying its share.
Prescription Drug Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Freedom Blue PPO Prestige has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 | $0.00 |
| Generic | $0.00 | $0.00 |
| Preferred Brand | 25.00% | 0.00% |
| Non-Preferred Drug | 50.00% | 0.00% |
| Specialty Tier | 33.00% | 33.00% |
| *The Part D deductible does not apply. | ||
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories using a 5-star rating system. Here are the most recent CMS ratings for Freedom Blue PPO Prestige .
| CMS Measure | Star Rating |
|---|---|
| 2025 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 |
Plan Availability
Freedom Blue PPO Prestige (H5106-032-1) is available in the following locations (click to open):
Additional Plan Options
The Medicare Part C program offers a myriad of HMO, PPO, and PFFS plan options, including these plans:
- H5106-013-0: Freedom Blue PPO Standard (PPO)
- H5106-030-1: Freedom Blue PPO Signature (PPO)
- H5106-031-1: Freedom Blue PPO Merit (PPO)
- H5106-029-1: Freedom Blue PPO Distinct (PPO)
- H5106-033-1: Freedom Blue PPO Valor (PPO)
- H5106-029-2: Freedom Blue PPO Distinct (PPO)
- H5106-032-2: Freedom Blue PPO Prestige (PPO)
If you are enrolled in a Part C plan with prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D plan, regardless of your chosen insurance company.
You cannot be enrolled in a Part C health plan and simultaneously hold Medicare Supplement Insurance (Medigap). Medicare Supplement plans are only compatible with Medicare Parts A and B.
Contact Us About Highmark Blue Cross Blue Shield
| Website: | Highmark Blue Cross Blue Shield Plan Page (opens in new tab) |
|---|---|
| Providers: | Highmark Blue Cross Blue Shield Providers Page (opens in new tab) |
| Formulary: | Highmark Blue Cross Blue Shield Formulary Page (opens in new tab) |
| Pharmacy: | Highmark Blue Cross Blue Shield Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (866)739-1899 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (866)739-1899 |
| New Member Part D TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Part C program on www.medicare.gov or call 1-800-MEDICARE.
Citations & References
- Highmark Blue Cross Blue Shield, http://medicare.highmark.com, Last Accessed March 1, 2025
- Medicare.gov, "Medicare Advantage Plans cover all Medicare services", Last Accessed February 20, 2024
- Medicare.gov, "Compare Original Medicare & Medicare Advantage", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You Handbook", Last Accessed March 19, 2025
- Medicare.gov, "Is Your Test, Item, or Service Covered?", Last Accessed March 19, 2025
- CMS.gov, Landscape Source Files, Last Accessed March 15, 2025
- CMS.gov, Medicare Part C & D Performance, Last Accessed March 15, 2025
- CMS.gov, Plan Benefits Package,Last Accessed March 15, 2025
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
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