Medicare Advantage · Local PPO
Highmark Blue Cross Blue Shield or Highmark Blue Shield
Plan year 2026

Freedom Blue PPO Basic (PPO) H3916-012

4.5 · 2026 Star Rating · source: CMS · Ratings are updated annually
Monthly premium
$41
+ your Part B premium
Max out-of-pocket
$5,900
in-network annual cap
Primary care
$0
per visit copay
Specialist
$35
per visit
This plan includes a Part B giveback, which lowers what you pay for your Medicare Part B premium by up to $18 a month. Depending on how you pay Part B, the reduction may appear in your Social Security payment or on your Part B bill. That is up to $216 a year. Processing can take time; confirm the amount and timing with the plan.
This plan does not include Part D drug coverage
Before enrolling, confirm how your prescriptions will be covered. Whether you can add a standalone Part D plan depends on the Medicare Advantage plan type; pairing one with most MA HMO or PPO plans can disenroll you from Medicare Advantage. A gap in creditable drug coverage may lead to a Part D late enrollment penalty later.

Part D late enrollment penalty

If you go 63 days or more in a row after your Part D initial enrollment period without Part D or other creditable prescription drug coverage, you may owe a penalty if you join Part D later. The penalty is 1% of the national base beneficiary premium ($38.99 in 2026) for each full uncovered month. It is added to your monthly Part D premium for as long as you have Part D, and the base premium can change each year.

Who this type of plan may fit

MA-Only plans are generally considered by people who already have creditable prescription drug coverage, such as coverage from the VA, TRICARE, or a current or former employer or union. Your coverage provider—not this page—must tell you whether your current drug coverage is creditable.

Before you enroll
  • Find your current plan's annual Notice of Creditable Coverage or ask its benefits administrator.
  • Confirm in this plan's official documents whether adding a standalone drug plan is allowed.
  • Do not drop existing drug coverage until you understand how the change affects both coverages.
Review the creditable coverage checklist

Your costs at a glanceIn-network, for the 2026 plan year

Drug coverage
Not included
Inpatient hospital
$340
per stay
no limit on covered hospital days
Inpatient mental health
$340
per stay
Outpatient surgery
$200
Emergency room
$130
Urgent care
$50

What's included, and what it's actually worth6 benefits included. Tap any card for the detail

Part B giveback

$18/month
DetailsThis plan includes a Part B giveback, which lowers what you pay for your Medicare Part B premium by up to $18 a month.
Processing can take time; confirm the amount and timing with the plan.

Hearing

$500/yr hearing aid allowance
Hearing aid allowance$500/yr hearing aid allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.

Vision

$425/yr eyewear allowance
Eyewear allowance$425/yr eyewear allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.
See more details about this plan
Doctor Visits: PCP$0 copay
In-network$0 copay per visit
Doctor Visits: Specialist$35 copay
In-network$35 copay per visit
Inpatient Hospital$340 per stay
In-network$340 per stay
Benefit limitNone — additional covered days are unlimited
Outpatient Surgery$200 copay
In-network$200 copay per procedure
Mental Health$340 per stay
Inpatient psychiatric$340 per stay
DentalPreventive dental (cost sharing varies by service)
DetailsPreventive dental (cost sharing varies by service)
This is a supplemental benefit with plan-specific limits. See plan documents for details.
Transportation24 one-way trips/year
Trips per year24 one-way trips/year
MealsMeal benefit

Your coverageCheck your coverageFrom the doctors you added

Our take

Where this plan shines

See your primary doctor for $0.
Highly rated by CMS (4.5 stars).

Things to know before you enroll

This plan’s out-of-pocket maximum is above the national median.
Limited coverage while traveling outside the plan’s service area.
Does not include prescription drug coverage — confirm whether you can keep other creditable coverage or pair this plan with a standalone Part D plan.
Late enrollment penalty risk if you go without creditable drug coverage for 63+ days.
Questions? Talk to a licensed agent at1-866-764-3312 (TTY: 711)

Plan documents

Plan questions

Common questions about Freedom Blue PPO Basic (PPO) (Local PPO)

What does Freedom Blue PPO Basic (PPO) (Local PPO) cover?

Freedom Blue PPO Basic (PPO) (Local PPO) is a Medicare Advantage plan that the current plan record identifies as not including Part D prescription drug coverage. The plan record does not identify Part D prescription drug coverage. Published supplemental benefits include dental (Preventive dental (cost sharing varies by service)), vision ($425/yr eyewear allowance), hearing ($500/yr hearing aid allowance), and transportation (24 one-way trips/year). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

Learn about Medicare Advantage

How much does Freedom Blue PPO Basic (PPO) (Local PPO) cost in 2026?

The published 2026 monthly plan premium for Freedom Blue PPO Basic (PPO) (Local PPO) is $41. The standard Part B premium is $202.90/month in 2026 for most people; assistance may pay it for some members. The in-network medical out-of-pocket maximum is $5,900; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $35. These figures are plan data, not a personal yearly-cost estimate.

Can I use my current doctors with Freedom Blue PPO Basic (PPO) (Local PPO)?

CMS lists Freedom Blue PPO Basic (PPO) (Local PPO) as a Local PPO plan. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.

Check your doctors

Does Freedom Blue PPO Basic (PPO) (Local PPO) include prescription drug coverage?

Freedom Blue PPO Basic (PPO) (Local PPO) is listed in the current plan record as a Medicare Advantage plan without Part D prescription drug coverage. Do not assume that a separate standalone Part D plan can be added: many Medicare Advantage plans cannot be paired with a PDP, and joining one can affect Medicare Advantage enrollment. Confirm this plan's rules and how your prescriptions will be covered before enrolling.

Browse standalone Part D plans

What extra benefits does Freedom Blue PPO Basic (PPO) (Local PPO) offer beyond Original Medicare?

The current plan record for Freedom Blue PPO Basic (PPO) (Local PPO) lists dental (Preventive dental (cost sharing varies by service)), vision ($425/yr eyewear allowance), hearing ($500/yr hearing aid allowance), transportation (24 one-way trips/year), and meals (Meal benefit). The current data does not list over-the-counter (OTC) and fitness as offered benefits. It also lists a Part B premium reduction of $18 per month. Benefit allowances, frequency, eligibility, and participating providers can have additional limits, so review the Summary of Benefits or Evidence of Coverage for the complete rules.

When can I enroll in Freedom Blue PPO Basic (PPO) (Local PPO)?

Freedom Blue PPO Basic (PPO) (Local PPO) is a 2026 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. A qualifying circumstance may create a Special Enrollment Period outside those dates. Confirm the enrollment window and effective date that apply to you before changing coverage.

Review Medicare enrollment periods

More plan options

Browse the full 2026 Medicare Advantage without drug coverage directory. This plan is offered in Pennsylvania. Plan availability can vary by county.

Helpful next steps

Freedom Blue PPO Basic H3916-012 (PPO) — 2026 Costs & Benefits