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NextBlue Freedom PPO (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for NextBlue Freedom PPO (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on NextBlue Freedom PPO (PPO) in 2025, please refer to our full plan details page.
NextBlue Freedom PPO (PPO) is a PPO plan offered by Blue Cross Blue Shield of Michigan Mutual Ins. Co. available for enrollment in 2025 to people living in North Dakota. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that NextBlue Freedom PPO (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 NextBlue Freedom PPO (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 NextBlue Freedom PPO (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.
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.
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 $5500.00 (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 $5500.00 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:
Sign up for NextBlue Freedom PPO (PPO)
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Drug Coverage
Prescription drugs are not covered by NextBlue Freedom PPO (PPO).
Additional Benefits
The NextBlue Freedom PPO (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. Emergency services, primary care, and preventive services are covered, often with no copay. The plan also includes coverage for hearing, vision, and dental services, with specific copays and maximum benefits for hearing aids, contact lenses, and frames. Additional benefits include ambulance services with copays or coinsurance, along with home infusion, dialysis, and medical equipment coverage. The plan also provides coverage for skilled nursing facilities, and other services such as OTC items with a quarterly allowance. However, certain services like cardiac rehabilitation, and some other specialized services are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-4, the copay is $375, and for days 5-90, there is no copay. Additional Days for Inpatient Hospital-Acute is covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The NextBlue Freedom PPO (PPO) plan covers outpatient services, including outpatient hospital services with a copay of $300-$350, observation services with a copay of $275, and outpatient substance abuse services with a copay of $30 for both individual and group sessions. Ambulatory Surgical Center (ASC) Services and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the NextBlue Freedom PPO (PPO) plan. This benefit has a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $120 copay, Urgently Needed Services has a $40 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $120 copay.
Primary Care See details
The NextBlue Freedom PPO (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $25 copay, while physician specialist services cost $30. Mental health and psychiatric services, along with opioid treatment program services, have a $30 copay for individual and group sessions, while other health care professionals have a copay ranging from $0 to $30. Physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have a copay between $0 and $40. Podiatry services are not covered.
Preventive Services See details
The NextBlue Freedom PPO (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services may have a copay, and some services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams are covered once per year. Fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids are covered with a maximum benefit of $1,000 per year. OTC hearing aids are covered with a maximum benefit of $50 per ear every three months.
Vision Services See details
Vision services include eye exams with a copay of $0-$30, and eyewear benefits, including contact lenses, eyeglass lenses, eyeglass frames, and upgrades. Contact lenses are covered with a maximum benefit of $200 per year, and eyeglass frames have a maximum benefit of $200 per year. Eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services include a $30 copay for Medicare Dental Services. Other dental services include oral exams (2 visits per year), dental x-rays (1 per year), prophylaxis (cleaning, 2 visits per year), and fluoride treatment (1 per year). Restorative services, endodontics, prosthodontics, and prosthodontics all have 25% coinsurance, while periodontics and oral and maxillofacial surgery have 0-25% coinsurance; however, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services have a maximum plan benefit of $750 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the NextBlue Freedom PPO (PPO) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs and a coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the NextBlue Freedom PPO (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the NextBlue Freedom PPO (PPO) plan. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $150, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $325, and Therapeutic Radiological Services have a minimum coinsurance of 20%. Outpatient X-Ray Services have a copay of $15.
Home Health Services See details
Home Health Services are covered by the NextBlue Freedom PPO (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 NextBlue Freedom PPO (PPO) plan. 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, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the NextBlue Freedom PPO (PPO) plan, but require prior authorization. For days 1-20, there is no copay; for days 21-48, the copay is $150; and for days 49-100, there is no copay. Additional days beyond Medicare-covered, and non-Medicare-covered stays, are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items with a maximum plan benefit of $50.00 every three months. Acupuncture, meal benefits, 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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