A non-government entity
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 2026, 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 3.5 out of 5 stars in 2026.
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 $6500.00 (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 $6500.00 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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by NextBlue Freedom PPO (PPO).
Additional Benefits
The NextBlue Freedom PPO (PPO) plan offers robust coverage for core medical services with predictable cost-sharing and no coinsurance for many key benefits. Members enjoy no copay for primary care visits, while specialist visits and urgent care require copays ranging from $15 to $50. Inpatient hospital stays require a $425 daily copay for the first four days followed by no copay, while emergency room visits incur a $125 copay. This plan also features valuable supplemental benefits, including no copays for routine hearing and preventive dental services, alongside a $650 annual allowance for both eyewear and dental care. Additionally, members receive no-copay home health services and an over-the-counter benefit of up to $50 every three months. Most diagnostic, preventive, and routine vision exams are covered with low to no copays and no coinsurance, keeping out-of-pocket costs highly manageable.
Inpatient Hospital See details
NextBlue Freedom PPO (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $425 daily copay for days 1 through 4 and no copay for days 5 through 90. Inpatient hospital benefits are partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
NextBlue Freedom PPO (PPO) covers outpatient services with no coinsurance, featuring a $350 to $400 copay for outpatient hospital services and a $175 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $50 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by NextBlue Freedom PPO (PPO) with a $95.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance services under NextBlue Freedom PPO (PPO) require prior authorization and are covered with a $250.00 copay (and no coinsurance) for ground transport and a 20% coinsurance (and no copay) for air transport. Additional transportation services to health-related locations are not covered by this plan.
Emergency Services See details
NextBlue Freedom PPO (PPO) covers emergency services with a $125 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum benefit with copays ranging from $50 to $125 and no coinsurance.
Primary Care See details
Primary care benefits under the NextBlue Freedom PPO (PPO) offer primary care doctor visits and opioid treatment with no copay and no coinsurance, while podiatry services are not covered. Other covered services, including specialist visits, chiropractic care, mental health services, and physical therapy, require copays ranging from $15 to $50 and no coinsurance.
Preventive Services See details
NextBlue Freedom PPO (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. However, additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
NextBlue Freedom PPO (PPO) covers hearing services with no copay and no coinsurance, which includes one routine hearing exam per year and unlimited fitting evaluations. Prescription hearing aids are partially covered up to $650 per ear annually, though inner ear, outer ear, and over the ear types are not covered, while OTC hearing aids are covered up to $50 per ear every three months for in-network services.
Vision Services See details
NextBlue Freedom PPO (PPO) partially covers vision services, offering one routine annual eye exam with no deductible, a $0 to $50 copay, and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $650 combined maximum annual benefit for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by NextBlue Freedom PPO (PPO), with adjunctive general services not covered. Medicare-covered dental services require a $50 copay and no coinsurance, while other covered diagnostic, preventive, restorative, and orthodontic services feature no copay and no coinsurance up to a $650 yearly maximum for both in-network and out-of-network care.
Home Infusion bundled Services See details
NextBlue Freedom PPO (PPO) covers home infusion bundled services with no copay and no coinsurance, although prior authorization is required. Under this plan, Medicare Part B chemotherapy, radiation, and other Part B drugs require no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
NextBlue Freedom PPO (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
NextBlue Freedom PPO (PPO) partially covers Medical Equipment with no copays, though prior authorization is required for some items. Durable medical equipment ranges from no coinsurance to 20% coinsurance, while prosthetics, medical supplies, and diabetic therapeutic shoes require a 20% coinsurance; however, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
NextBlue Freedom PPO (PPO) covers diagnostic services with no coinsurance, featuring a $10 copay for lab services and copays ranging from no copay up to $175 for diagnostic tests. Covered radiological services require a $20 copay for outpatient X-rays, diagnostic radiology starting at no copay, and a minimum 20% coinsurance for therapeutic radiology, with prior authorization required for both service types.
Home Health Services See details
NextBlue Freedom PPO (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered in practice by NextBlue Freedom PPO (PPO) because all key sub-services—including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET)—are excluded, despite the plan technically offering no coinsurance.
Skilled Nursing Facility (SNF) See details
NextBlue Freedom PPO (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires prior authorization, with no prior three-day inpatient hospital stay required. There is no copay for days 1 to 20 and days 56 to 100, a $200 daily copay for days 21 to 55, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
NextBlue Freedom PPO (PPO) partially covers other services, offering an over-the-counter (OTC) benefit of up to $50 every three months with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved