Freedom Blue PPO Valor (PPO) Medicare Advantage Plan H3916-056 • 2027
CMS Rating:
(4.5 out of 5 stars*)
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $6000.00In-network
- Part B Giveback
- −$125.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 156 beneficiaries
Last update:
Freedom Blue PPO Valor (PPO) Introduction
Freedom Blue PPO Valor is a Medicare Advantage PPO plan offered by Highmark Blue Cross Blue Shield or Highmark Blue Shield. It uses a Preferred Provider Organization (PPO) provider network and comes without prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $0.00 medical deductible, and $6000.00 in-network maximum out-of-pocket. CMS Plan ID H3916-056 identifies this plan.
Plan Benefits
Freedom Blue PPO Valor has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H3916-056.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: 40% coinsurance |
In-network: $0 copay Out-of-network: 40% coinsurance |
| Specialist | In-network: $10 copay Out-of-network: 40% coinsurance |
In-network: $10 copay Out-of-network: 40% coinsurance |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay |
| Telehealth benefit | In-network: $0-$40 copay | In-network: $0-$40 copay |
| Routine chiropractic | In-network: $15 copay Out-of-network: 40% coinsurance |
In-network: $15 copay Out-of-network: 40% coinsurance |
| Fitness benefits | Coming soon | In-network: $0 copay Out-of-network: 50% coinsurance |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Health transportation (non-emergency) | Coming soon | In-network: $0 copay Out-of-network: 30% coinsurance |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $225 copay Out-of-network: 40% coinsurance |
In-network: $225 copay Out-of-network: 40% coinsurance |
| Lab services | In-network: $0-$10 copay Out-of-network: 40% coinsurance |
In-network: $0-$10 copay Out-of-network: 40% coinsurance |
| Outpatient x-rays | In-network: $20 copay Out-of-network: 40% coinsurance |
In-network: $20 copay Out-of-network: 40% coinsurance |
| Diagnostic tests and procedures | In-network: $0-$10 copay Out-of-network: 40% coinsurance |
In-network: $0-$10 copay Out-of-network: 40% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $130 copay | $130 copay |
| Worldwide emergency care | Coming soon | $130 copay |
| Urgent care | $40 copay | $40 copay |
| Inpatient hospital care | In-network: Tier 1 $300 per stay Out-of-network: $395 per stay |
In-network: Tier 1 $300 per stay Out-of-network: $395 per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $221 per day for days 21-100 Out-of-network: 30% per stay |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 Out-of-network: 30% per stay |
| Ground ambulance | In-network: $310 copay Out-of-network: $310 copay, 30% coinsurance |
In-network: $310 copay Out-of-network: $310 copay, 30% coinsurance |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $5 copay Out-of-network: 40% coinsurance |
In-network: $5 copay Out-of-network: 40% coinsurance |
| Outpatient group therapy | In-network: $5 copay Out-of-network: 40% coinsurance |
In-network: $5 copay Out-of-network: 40% coinsurance |
| Inpatient psychiatric hospital care | In-network: Tier 1 $300 per stay Out-of-network: $395 per stay |
In-network: Tier 1 $300 per stay Out-of-network: $395 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $10 copay Out-of-network: 40% coinsurance |
In-network: $15 copay Out-of-network: 40% coinsurance |
| Occupational therapy | In-network: $10 copay Out-of-network: 40% coinsurance |
In-network: $15 copay Out-of-network: 40% coinsurance |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: 0%-20% coinsurance Out-of-network: 40% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 40% coinsurance |
| Durable medical equipment | In-network: 0%-50% coinsurance Out-of-network: 40%-50% coinsurance |
In-network: 0%-50% coinsurance Out-of-network: 40%-50% coinsurance |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: 30% coinsurance |
In-network: $0 copay Out-of-network: 30% coinsurance |
| Dental x-rays | In-network: $0 copay Out-of-network: 30% coinsurance |
In-network: $0 copay Out-of-network: 30% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: 30% coinsurance |
In-network: $0 copay Out-of-network: 30% coinsurance |
| Periodontics | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Endodontics | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Restorative services | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $50 copay |
In-network: $0 copay Out-of-network: $50 copay |
| Contact lenses | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass frames only | In-network: $0-$40 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass lenses only | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglasses (frames & lenses) | In-network: $0-$40 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Upgrades | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Fitting/evaluation | Not covered | Not covered |
| Prescription hearing aids | In-network: $699-$999 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $699-$999 copay Out-of-network: $0 copay, 0% coinsurance |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
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 Performance Ratings (Contract ID: H3916)
Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.
| CMS Measure | Star Rating |
|---|---|
| 2027 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 |
Contact Information for Highmark Blue Cross Blue Shield or Highmark Blue Shield
- Website
- Highmark Blue Cross Blue Shield or Highmark Blue Shield Plan Page
- Providers
- Highmark Blue Cross Blue Shield or Highmark Blue Shield Providers Page
- Formulary
- Highmark Blue Cross Blue Shield or Highmark Blue Shield Formulary Page
- Pharmacy
- Highmark Blue Cross Blue Shield or Highmark Blue Shield Pharmacy Page
- New Member Health Plan Help
- (866)743-5478
- New Member Health Plan TTY
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Freedom Blue PPO Valor (H3916-056-0) is available in the following locations:
Pennsylvania Counties Served
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Freedom Blue PPO Valor (PPO)
How much does plan H3916-056 cost per month?
The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.
What is the annual out-of-pocket maximum (MOOP) for this plan?
The annual in-network MOOP is $6000.00 for 2027. After this limit is reached, covered in-network services are fully paid.
How many beneficiaries are enrolled in this plan?
CMS reports 156 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $0.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | November 10, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Highmark Blue Cross Blue Shield or Highmark Blue Shield (official source) | http://medicare.highmark.com | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Explore your Medicare coverage options | 25 May, 2025 |
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