Freedom Blue PPO Valor (PPO) Medicare Advantage Plan H3916-067 • 2026 • Jefferson County, PA

Freedom Blue PPO Valor Overview

Coverage Overview for Freedom Blue PPO Valor

As a Medicare Advantage PPO plan, Freedom Blue PPO Valor covers Medicare Part A and Part B services and allows access to Medicare-approved providers. The monthly premium is $0.00, with lower costs when using in-network providers.

Primary care visits have a $0 copay | Out-of-network: 40% coinsurance, specialist visits come with a $10 copay | Out-of-network: 40% coinsurance, urgent care services carry a $40 copay, and ambulance transportation is $330 copay | Out-of-network: $330 copay, 30% coinsurance. These expenses apply toward the annual maximum out-of-pocket (MOOP) limit of $6000.00. After this limit is reached, in-network services are fully covered.

This plan is registered with CMS under Plan ID H3916-067. Cost-sharing details are outlined below.

Out-of-Pocket Costs

Freedom Blue PPO Valor includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The table below outlines the most common in-network out-of-pocket costs associated with plan H3916-067.

Certain preventive services are covered 100% by Freedom Blue PPO Valor as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

CMS 5-Star Ratings

CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.