Plan H5106-033-2: Freedom Blue PPO Valor (PPO) – 2025 Coverage Details
This page provides coverage, cost, and availability details for Highmark Blue Cross Blue Shield’s H5106-033-2 Medicare Advantage plan for 2025.
*CMS rated this Highmark Blue Cross Blue Shield plan (H5106-033-2) 4.5 (Good+) out of 5 stars.
Freedom Blue PPO Valor Basic Plan Details
- Plan ID
- H5106-033-2
- Plan Type
- PPO
- Plan Year
- 2025
- Premium
- $0.00/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 6,000.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Not Included
- 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 H5106-033-2.
NOTE: Certain preventive services are covered 100% by the plan as a Part B benefit.
Doctor's Office Visits
- Primary
- Not Covered
- Specialist
- $10 Copay
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $125 Copay
- Urgent care
- $50 Copay
- Ground ambulance
- $300 Copay
- Inpatient hospital care
- $275.00 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)
- $10 Copay
- Routine Foot Care
- $10 Copay
Chiropractic Care
- Medicare-covered chiropractic
- $15 Copay
Prior Authorization Required - Routine chiropractic
- Not Covered
Mental Health Services
- 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
Rehabilitation Services
- Physical therapy and speech and language therapy
- $15 Copay
Prior Authorization Required - Occupational therapy
- $15 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
- $225 Copay
Prior Authorization Required - Lab services
- Not Covered
- Outpatient x-rays
- $20 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
- $10 Copay
- Oral exam
- $0
- Dental x-rays
- $0
- Cleaning
- $0
- Periodontics
- Not Covered
- Endodontics
- Not Covered
- Restorative Services
- Not Covered
- Maximum dental benefit
- $2,000.00 (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
- $ to $10 Copay
- Routine eye exam
- Covered
Limits may apply - Eyewear benefits
- None
Get a copy of the Freedom Blue PPO Valor Summary of Benefits.
Prescription Drug Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Rating Marks
The following table shows the quality ratings for this Highmark Blue Cross Blue Shield plan. Each year 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 ratings for Freedom Blue PPO Valor .
| 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 Valor (H5106-033-2) 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:
- H5106-030-2: Freedom Blue PPO Signature (PPO)
- H5106-032-1: Freedom Blue PPO Prestige (PPO)
- H5106-032-2: Freedom Blue PPO Prestige (PPO)
- H5106-031-2: Freedom Blue PPO Merit (PPO)
- H5106-029-2: Freedom Blue PPO Distinct (PPO)
- H5106-033-2: Freedom Blue PPO Valor (PPO)
- H5106-031-1: Freedom Blue PPO Merit (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) |
| New Member Health Plan Help: | (866)739-1899 |
| New Member Health Plan TTY: | 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, "What Medicare Covers", 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.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.