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BlueMedicare Freedom Giveback (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueMedicare Freedom Giveback (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueMedicare Freedom Giveback (PPO) in 2025, please refer to our full plan details page.
BlueMedicare Freedom Giveback (PPO) is a PPO plan offered by USAble Mutual Insurance Company available for enrollment in 2025 to people living in Select Counties in Arkansas. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that BlueMedicare Freedom Giveback (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 BlueMedicare Freedom Giveback (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 BlueMedicare Freedom Giveback (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 $75.00. 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 $9550.00 (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 $9550.00 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 BlueMedicare Freedom Giveback (PPO).
Additional Benefits
The BlueMedicare Freedom Giveback (PPO) plan offers comprehensive coverage with a focus on outpatient and preventive services. This plan features no copays for primary care, additional telehealth benefits, home health services, diabetic supplies, and many preventive services. It also includes coverage for inpatient hospital stays, outpatient services, and emergency services, with varying copays and coinsurance depending on the specific service. Additional benefits include hearing, vision, and dental coverage, with copays or coinsurance for certain services and maximum annual benefits for hearing aids and dental services. The plan also provides coverage for medical equipment, home infusion, and dialysis services, and offers an over-the-counter (OTC) benefit and a meal benefit with no copay. However, some services like certain dental, vision, and hearing aids are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization. For the first 5 days, the copay is $375 per admission, and there is no copay for days 6-90.
Outpatient Services See details
Outpatient Services includes coverage for outpatient hospital services with a $300 copay, observation services with a $300 copay, and ambulatory surgical center services with a $250 copay. Outpatient substance abuse services have a $30 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueMedicare Freedom Giveback (PPO) plan, with a copay of $85.00. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueMedicare Freedom Giveback (PPO) plan, with ground ambulance services costing a $325 copay, and air ambulance services incurring a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services with the BlueMedicare Freedom Giveback (PPO) plan includes a $125 copay, while Urgently Needed Services have a $35 copay. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a 20% coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueMedicare Freedom Giveback (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a $35 copay, Mental Health Specialty Services with a $35 copay for individual and group sessions, Podiatry Services with a $35 copay for Medicare-covered services and routine foot care, Other Health Care Professional services with a copay between $0 and $35, Psychiatric Services with a $35 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $35 copay, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with a $40 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero dollar preventive services, annual physical exams with no copay, and additional preventive services with no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. The plan does not cover Health Education, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a maximum plan benefit of $1000 every three years, and all types of prescription hearing aids have no copay. OTC hearing aids are not covered, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$35, and eyewear has a combined maximum benefit of $150 per year with no copay for covered services, except eyeglass lenses and eyeglass frames, which are not covered.
Dental Services See details
Dental services include a $35 copay for Medicare dental services, no copay for oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery have a 20% coinsurance. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. This plan has a maximum benefit coverage of $3,000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BlueMedicare Freedom Giveback (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, and Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with no copay, and a coinsurance that is at most 20% for diagnostic procedures/tests and lab services. Diagnostic Radiological Services have a copay that is at most $300.00, while Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the BlueMedicare Freedom Giveback (PPO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the BlueMedicare Freedom Giveback (PPO) plan, with a $0 copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The BlueMedicare Freedom Giveback (PPO) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit of $50 every three months, and also covers a Meal Benefit with no copay. Acupuncture, 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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