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Shared Health Dual Freedom (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Shared Health Dual Freedom (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Shared Health Dual Freedom (PPO D-SNP) in 2025, please refer to our full plan details page.
Shared Health Dual Freedom (PPO D-SNP) is a PPO D-SNP plan offered by BlueCross BlueShield of Tennessee available for enrollment in 2025 to people living in Texas. The overall rating for this plan is not yet available for 2025.
It's important to know that Shared Health Dual Freedom (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Shared Health Dual Freedom (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Shared Health Dual Freedom (PPO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Shared Health Dual Freedom (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.30. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $14000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $14000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Shared Health Dual Freedom (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), you will pay $18.30 per month for Part D.
Additional Benefits
The Shared Health Dual Freedom (PPO D-SNP) plan provides coverage for a wide range of services. Inpatient hospital stays require a $1,990 copay, while outpatient services, primary care, emergency services, and many other services have a 20% coinsurance. Preventive services are covered with no copay for Medicare-covered services, and some other services have a 20% coinsurance. The plan also includes dental, vision, and hearing benefits, along with additional benefits such as home infusion, dialysis, and medical equipment coverage. Other services include acupuncture, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a copay of $1,990 for a Medicare-covered stay, but additional days, non-Medicare-covered stays, and upgrades are not covered. Prior authorization is required for these services.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services and Observation Services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services, Individual Sessions for Outpatient Substance Abuse, and Group Sessions for Outpatient Substance Abuse have a minimum and maximum coinsurance of 20%. Outpatient Blood Services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a 20% coinsurance, while Transportation Services to a Plan Approved Health-related Location are covered with no copay or coinsurance. Transportation Services to any Health-related Location are not covered.
Emergency Services See details
Emergency Services are covered by the Shared Health Dual Freedom (PPO D-SNP) plan with a 20% coinsurance, and no copay. Urgently Needed Services are covered with a 20% coinsurance and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The Shared Health Dual Freedom (PPO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician, specialist, and physical therapy services have a 20% coinsurance, while chiropractic and podiatry services have a 20% coinsurance for routine foot care, and the plan covers up to 12 routine chiropractic visits per year. Occupational therapy, mental health specialty, psychiatric services, and opioid treatment program services have a minimum and maximum 20% coinsurance.
Preventive Services See details
The Shared Health Dual Freedom (PPO D-SNP) plan covers preventive services, including Medicare-covered services with no copay, and other preventive services with 20% coinsurance. The plan does not cover annual physical exams, health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing services are covered, including routine hearing exams with a 20% coinsurance, and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, but not for inner ear, outer ear, or over the ear hearing aids. OTC hearing aids are not covered.
Vision Services See details
Shared Health Dual Freedom (PPO D-SNP) covers vision services, including routine eye exams with 20% coinsurance, and eyewear with a $300 allowance per year for glasses and/or contact lenses, with 20% coinsurance for contact lenses. Upgrades are not covered.
Dental Services See details
Dental services are covered under the Shared Health Dual Freedom (PPO D-SNP) plan, with a 20% coinsurance for Medicare Dental Services. Other dental services have a maximum benefit of $3500 per year, covering oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0-20%, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Shared Health Dual Freedom (PPO D-SNP) plan. The plan has a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered under the Shared Health Dual Freedom (PPO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Equipment has a 20% coinsurance for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Shared Health Dual Freedom (PPO D-SNP) plan. There is no copay for any of the services. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Shared Health Dual Freedom (PPO D-SNP) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Shared Health Dual Freedom (PPO D-SNP) plan, but the plan does not cover the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is coinsurance for the covered services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Shared Health Dual Freedom (PPO D-SNP) plan, with prior authorization required. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Shared Health Dual Freedom (PPO D-SNP) plan covers acupuncture with a 20% coinsurance and a limit of 20 treatments per year. Over-the-counter items are covered up to $135.00 per month, including nicotine replacement therapy and Naloxone. The plan also provides a meal benefit for a chronic illness, with a limit of 14 meals following an acute inpatient or SNF discharge stay. However, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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