Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H3916-015-000

Freedom Blue PPO Standard (PPO) · Highmark Blue Cross Blue Shield or Highmark Blue Shield · Central and Northeastern PA

Compact plan code: H3916015000

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Freedom Blue PPO Standard (PPO)

H3916-015-000 Central and Northeastern PA Local PPO
Open in quick lookup
01

In-network

Inpatient hospital

Per admission $475 per stay
Plan-listed inpatient copay $475
02

Emergency transport

Ambulance

Ground · in-network$260 copay
Air · in-network$260 copay
03

Emergency services

Emergency room

$130 copay

Waived if admitted

04

Medical maximum

Maximum out-of-pocket

In-network$5,000
Combined in + out$8,950
05

Skilled care at home

Home health

In-networkNo cost share reported
Out-of-network30% coinsurance
06

Monthly cost

Premium & giveback

Part C premium$22.80 / month
Consolidated C + D$121 / month

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. Quick-reference values should be confirmed in current official plan documents.

PBP benefits ↗ Landscape data ↗

Same CMS contract

H3916-001-000 Freedom Blue PPO Classic (PPO) Southwestern PA · Local PPO H3916-002-000 Freedom Blue PPO Classic (PPO) West Central PA · Local PPO H3916-005-000 Freedom Blue PPO Deluxe (PPO) Central and Northeastern PA · Local PPO H3916-012-000 Freedom Blue PPO Basic (PPO) Central and Northeastern PA · Local PPO H3916-018-000 Freedom Blue PPO ValueRx (PPO) Central and Northeastern PA · Local PPO H3916-022-000 Freedom Blue PPO Select (PPO) Southwestern PA · Local PPO H3916-024-000 Freedom Blue PPO Select (PPO) West Central PA · Local PPO H3916-032-000 Freedom Blue PPO ValueRx (PPO) Southwestern PA · Local PPO

About this code

What H3916-015-000 identifies

H3916-015-000 is a Contract Year 2026 Medicare plan segment code. The compact form H3916015000 refers to the same normalized contract, plan, and segment shown on this page.

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.