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Blue Medicare Freedom+ (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare Freedom+ (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Medicare Freedom+ (PPO) in 2025, please refer to our full plan details page.
Blue Medicare Freedom+ (PPO) is a PPO plan offered by Blue Cross and Blue Shield of North Carolina available for enrollment in 2025 to people living in Select North Carolina Counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Blue Medicare Freedom+ (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Blue Medicare Freedom+ (PPO).
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 Blue Medicare Freedom+ (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $100.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Blue Medicare Freedom+ (PPO).
Additional Benefits
The Blue Medicare Freedom+ (PPO) plan offers coverage for a variety of services with varying cost-sharing. Hospital stays require an $816 copay for days 1-60. Outpatient services, including primary care, specialist visits, and mental health services, typically have a 20% coinsurance. Preventive services include an annual physical exam with no copay. Emergency services have a $100 copay, while transportation services have no copay for up to 24 one-way trips per year. The plan also covers home health services and skilled nursing facility stays, but requires prior authorization for the latter.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered by Blue Medicare Freedom+ (PPO). For days 1-60, the copay is $816 per admission or stay.
Outpatient Services See details
Outpatient Services are covered by the Blue Medicare Freedom+ (PPO) plan, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, individual sessions for outpatient substance abuse, group sessions for outpatient substance abuse, and outpatient blood services each 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 by the Blue Medicare Freedom+ (PPO) plan. Ground and Air Ambulance Services have a 20% coinsurance, while Transportation Services have no copay. Transportation Services to any health-related location are covered for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services are covered under the Blue Medicare Freedom+ (PPO) plan, with a $100 copay, and no coinsurance. Urgently Needed Services are covered with a $45 copay, and no coinsurance, while Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Blue Medicare Freedom+ (PPO) plan covers primary care physician services with a 20% coinsurance, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a 20% coinsurance, and physical therapy and speech-language pathology services with a $30 copay. The plan also covers mental health and psychiatric services with a 20% coinsurance, other health care professional services with a 20% coinsurance, and opioid treatment program services with a 20% coinsurance. Additional telehealth benefits are available with a 0-20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Blue Medicare Freedom+ (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered, though the specific copays for these services may vary. Services such as health education, in-home safety assessments, medical nutrition therapy, and others are not covered.
Hearing Services See details
Hearing Services for Blue Medicare Freedom+ (PPO) include hearing exams with a coinsurance of at most 20%, while routine hearing exams and fitting/evaluation for hearing aids are not covered. Prescription hearing aids and OTC hearing aids are also not covered.
Vision Services See details
Vision services cover eye exams with a 20% coinsurance and no copay, but routine eye exams are not covered. Eyewear is covered with no copay, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are partially covered by the Blue Medicare Freedom+ (PPO) plan; Medicare Dental Services are covered with a 20% coinsurance, while Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Blue Medicare Freedom+ (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by Blue Medicare Freedom+ (PPO), including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Prosthetic Devices and Medical Supplies each have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts each have a coinsurance between 20% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Blue Medicare Freedom+ (PPO) plan. All diagnostic services and all radiological services are covered with no copay, and a coinsurance of at most 20% for diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by the Blue Medicare Freedom+ (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Blue Medicare Freedom+ (PPO) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Medicare Freedom+ (PPO) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, but for days 21-60, the copay is $214.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefit, with OTC items having no copay, and meal benefit requiring a doctor's referral and no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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