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Vermont Blue Advantage Freedom Plus PPO (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Vermont Blue Advantage Freedom Plus PPO (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Vermont Blue Advantage Freedom Plus PPO (PPO) in 2025, please refer to our full plan details page.
Vermont Blue Advantage Freedom Plus 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 State of Vermont. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Vermont Blue Advantage Freedom Plus PPO (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Vermont Blue Advantage Freedom Plus 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 Vermont Blue Advantage Freedom Plus PPO (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $71.00. 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.
This plan has a $225.00 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 $5000.00 (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 $5000.00 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 Vermont Blue Advantage Freedom Plus PPO (PPO) plan has a $225 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay a $10 copay for preferred generic drugs at a standard pharmacy, and a $47 copay for standard generic drugs. Specialty tier drugs have no copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Vermont Blue Advantage Freedom Plus PPO (PPO) plan offers a variety of additional benefits. The plan covers inpatient hospital stays with a $400 copay for the first four days, and no copay for days 5-90. Outpatient services, primary care, and preventive services often have no copay, while other services, like specialist visits, have copays ranging from $20-$35. This plan also includes coverage for hearing, vision, and dental services, with varying copays, and maximum benefits for hearing aids, contact lenses, and eyewear. Home health services have no copay, while ambulance services have a $300 copay. The plan provides coverage for other services such as over-the-counter items with a quarterly limit, and dialysis services with 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a $400 copay for days 1-4, and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for the Vermont Blue Advantage Freedom Plus PPO (PPO) plan includes coverage for all outpatient hospital services and observation services with a $300 copay, and Ambulatory Surgical Center (ASC) services with no copay. Outpatient Substance Abuse Services, including individual and group sessions, have no copay. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Vermont Blue Advantage Freedom Plus PPO (PPO) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $300 copay for both ground and air ambulance services, and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Vermont Blue Advantage Freedom Plus PPO (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $40 copay, and Worldwide Emergency Transportation has a $125 copay.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $20 copay. Occupational Therapy Services and Physical Therapy/Speech-Language Pathology Services have a $30 and $35 copay, respectively. Physician Specialist Services cost $35, while Mental Health and Psychiatric Services have no copay for individual or group sessions. Other Health Care Professional services have a copay between $0 and $35. Additional Telehealth Benefits have a copay between $0 and $40, and Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive services include Medicare-covered services, annual physical exams with no copay, and additional preventive services, although some services like health education, in-home safety assessments, medical nutrition therapy, and others are not covered. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are also covered with no copay.
Hearing Services See details
Hearing Services include routine hearing exams with no copay, and fitting/evaluation for hearing aids, each covered once per year. Prescription hearing aids are covered up to $1,250 per year per ear, but prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include routine eye exams with a copay between $0 and $35, and eyewear benefits. Contact lenses are covered with a maximum benefit of $300 per year, and eyeglass lenses and frames are covered with a limit of one pair per year, and eyeglass frames have a maximum benefit of $300 per year.
Dental Services See details
Dental services include a $35 copay for Medicare dental services. Oral exams, cleaning, and fluoride treatments are covered with limitations on the number of visits per year, and a $1,500 maximum benefit for orthodontics. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with limitations on the number of visits, and orthodontics, adjunctive general services, maxillofacial prosthetics, and implant services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Vermont Blue Advantage Freedom Plus PPO (PPO) plan, and prior authorization is required. 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 under the Vermont Blue Advantage Freedom Plus PPO (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, but DME for use outside the home is not covered. Diabetic Equipment includes Diabetic Supplies with no coinsurance and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay between $0 and $35, Lab Services with a $20 copay, and Outpatient X-Ray Services with a $10 copay. Therapeutic Radiological Services have a coinsurance of at least 20%, and Diagnostic Radiological Services have a maximum copay of $300.
Home Health Services See details
Home Health Services are covered by the Vermont Blue Advantage Freedom Plus 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 Vermont Blue Advantage Freedom Plus 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 under the Vermont Blue Advantage Freedom Plus PPO (PPO) plan, but require prior authorization. For days 1-20 and 49-100, there is no copay, while days 21-48 have a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for over-the-counter items, with a maximum benefit of $75.00 every three months, but does not cover acupuncture, meal benefits, or other listed services.
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