In-network
Inpatient hospital
inpatient coinsurance is selected but its percentage is missing
● CMS 2026 plan record
Freedom Blue PPO MAPD WV Performance (PPO)
Choose and order benefitsSelections are saved only on this device.
Emergency transport
Ambulance
Ground · in-network20% coinsurance
Air · in-network20% coinsurance
Emergency services
Emergency room
20% coinsurance
Waived if admitted
Medical maximum
Maximum out-of-pocket
In-network$8,300
Combined in + out$10,000
Skilled care at home
Home health
In-network0% coinsurance
Out-of-network0% coinsurance
Monthly cost
Premium & giveback
Part C premiumNot reported
Consolidated C + DNot reported
Quick view
Primary care physician
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Specialist
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Preventive care
In: 20% coinsurance · Out: 0% coinsurance
Quick view
Diagnostic procedures & tests
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Laboratory services
In: 0% coinsurance · Out: 20% coinsurance
Quick view
X-rays & standard imaging
In: 20% coinsurance · Out: 20% coinsurance
Quick view
MRI, CT & PET imaging
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Urgent care
In: Cost share not reported · Out: Not separately reported
Quick view
Emergency room
In: 20% coinsurance · Out: Not separately reported
Quick view
Ground ambulance
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Air ambulance
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Outpatient hospital
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Outpatient surgery / ASC
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Home health
In: 0% coinsurance · Out: 0% coinsurance
Quick view
Skilled nursing facility
In: Cost share not reported · Out: Not separately reported
Quick view
Cardiac & pulmonary rehabilitation
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Occupational therapy
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Physical & speech therapy
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Mental health services
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Substance use treatment
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Podiatry
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Chiropractic
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Dental
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Vision
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Hearing
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Transportation
Not reported in this CMS export
Quick view
Fitness & wellness
Not reported in this CMS export
Quick view
Over-the-counter allowance
Not reported in this CMS export
Quick view
Meals
Not reported in this CMS export
Plan details
All plan benefits
No benefits match that search.
Medical care3 benefits
Primary care physician
In-network20% coinsurance
Out-of-network20% coinsurance
Specialist
In-network20% coinsurance
Out-of-network20% coinsurance
Preventive care
In-network20% coinsurance
Out-of-network0% coinsurance
Diagnostics & imaging4 benefits
Diagnostic procedures & tests
In-network20% coinsurance
Out-of-network20% coinsurance
Laboratory services
In-network0% coinsurance
Out-of-network20% coinsurance
X-rays & standard imaging
In-network20% coinsurance
Out-of-network20% coinsurance
MRI, CT & PET imaging
In-network20% coinsurance
Out-of-network20% coinsurance
Urgent & hospital care6 benefits
Urgent care
In-networkCost share not reported
Out-of-networkNot separately reported
Emergency room
In-network20% coinsurance
Out-of-networkNot separately reported
Ground ambulance
In-network20% coinsurance
Out-of-network20% coinsurance
Air ambulance
In-network20% coinsurance
Out-of-network20% coinsurance
Outpatient hospital
In-network20% coinsurance
Out-of-network20% coinsurance
Outpatient surgery / ASC
In-network20% coinsurance
Out-of-network20% coinsurance
Recovery & therapy5 benefits
Home health
In-network0% coinsurance
Out-of-network0% coinsurance
Skilled nursing facility
In-networkCost share not reported
Out-of-networkNot separately reported
Cardiac & pulmonary rehabilitation
In-network20% coinsurance
Out-of-network20% coinsurance
Occupational therapy
In-network20% coinsurance
Out-of-network20% coinsurance
Physical & speech therapy
In-network20% coinsurance
Out-of-network20% coinsurance
Behavioral health2 benefits
Mental health services
In-network20% coinsurance
Out-of-network20% coinsurance
Substance use treatment
In-network20% coinsurance
Out-of-network20% coinsurance
Specialty care2 benefits
Podiatry
In-network20% coinsurance
Out-of-network20% coinsurance
Chiropractic
In-network20% coinsurance
Out-of-network20% coinsurance
Supplemental benefits7 benefits
Dental
In-network20% coinsurance
Out-of-network20% coinsurance
Vision
In-network20% coinsurance
Out-of-network20% coinsurance
Hearing
In-network20% coinsurance
Out-of-network20% coinsurance
Transportation
Not reported in this CMS exportNot reported in this CMS export
Fitness & wellness
Not reported in this CMS exportNot reported in this CMS export
Over-the-counter allowance
Not reported in this CMS exportNot reported in this CMS export
Meals
Not reported in this CMS exportNot reported in this CMS export
Plan costs & rulesCoverage overview
Premium & Part B giveback
Part C premium not reported · Part B giveback not separately reported
Maximum out-of-pocket (MOOP)
In-network$8,300
Combined in + out$10,000
Medical deductibles
In-networkNot reported
Out-of-networkNot reported
Network & referrals
Local PPO · Referrals: Not required · Out-of-network coverage: Yes
Prescription drugs0 tiers
Part D deductible
This plan is not present in the public CMS Landscape release
Using this plan
Understand H5106-806-000
Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.
Plan at a glance
A quick read on this plan
Freedom Blue PPO MAPD WV Performance (PPO) is a 2026 Local PPO offered by Highmark Blue Cross Blue Shield in ALL WV COUNTIES. The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. The plan record does not require referrals.
Common benefit costs
What you may pay
These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.
Routine care
- Primary care physician
- 20% coinsurance
- Specialist
- 20% coinsurance
- Laboratory services
- 0% coinsurance
Separate visits or services; costs are not added together.
Tests & outpatient care
- Diagnostic procedures & tests
- 20% coinsurance
- MRI, CT & PET imaging
- 20% coinsurance
- Outpatient hospital
- 20% coinsurance
The service setting and billing details can change what you pay.
Emergency & hospital care
- Emergency room
- 20% coinsurance
Actual costs depend on the care received and plan rules.
Helpful context
Terms worth knowing
Maximum out-of-pocket (MOOP)
This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.
Availability
Who can enroll
- Service area
- ALL WV COUNTIES (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VI, VT, WA, WI, WV, WY)
- Plan type
- Local PPO
- Contract / plan
- H5106-806
- Coverage year
- 2026
Enrollment is limited to people eligible through the sponsoring employer or group. Confirm eligibility and the exact service area with the plan before enrolling.
Supplemental coverage
Extra benefits reported
Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.
Dental20% coinsurance
Vision20% coinsurance
Hearing20% coinsurance
Plan-specific answers
Frequently asked questions
Where is H5106-806-000 available?
Freedom Blue PPO MAPD WV Performance (PPO) is listed for ALL WV COUNTIES (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VI, VT, WA, WI, WV, WY). Enrollment is limited to people eligible through the sponsoring employer or group.
What is the in-network maximum out-of-pocket limit for H5106-806-000?
The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $8,300. Prescription drug spending generally does not count toward this medical limit.
What does an emergency room visit cost on H5106-806-000?
The plan record lists 20% coinsurance, waived when an admission meets the plan's stated timing rule.
Does H5106-806-000 report extra benefits?
Yes. CMS reports dental, vision, hearing. See the detailed benefit rows and official plan documents for limits and conditions.
Source trail
Official CMS, Contract Year 2026
Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.
Plan context
Where H5106-806-000 fits
- Full CMS plan ID
H5106-806-000- Contract
H5106- Base plan code
H5106-806- Segment
000- Carrier
- Highmark Blue Cross Blue Shield
- Plan type
- Local PPO
- Service area
- ALL WV COUNTIES (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VI, VT, WA, WI, WV, WY)
45 additional service-area states listed in the CMS record.
County/service-area foundation
CMS service-area entries
These named entries come from a CMS contract-level service-area file. They describe the contract's published geography and must not be treated as proof that every segment has identical county-level rules.
- Aleutians East, AK · employer/group only
- Aleutians West, AK · employer/group only
- Anchorage, AK · employer/group only
- Bethel, AK · employer/group only
- Bristol Bay, AK · employer/group only
- Chugach, AK · employer/group only
- Copper River, AK · employer/group only
- Denali, AK · employer/group only
- Dillingham, AK · employer/group only
- Fairbanks North Star, AK · employer/group only
- Haines, AK · employer/group only
- Hoonah-Angoon, AK · employer/group only
3316 additional service-area entries are retained in the data record.
About this code
What H5106-806-000 identifies
H5106-806-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H5106-806, H5106 806, or the compact full CMS ID H5106806000 refer to this plan or its base plan code.
Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.