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Shared Health Dual Freedom (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Shared Health Dual Freedom (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Shared Health Dual Freedom (PPO D-SNP) in 2025, please refer to our full plan details page.
Shared Health Dual Freedom (PPO D-SNP) is a PPO D-SNP plan offered by BlueCross BlueShield of Tennessee available for enrollment in 2025 to people living in Mississippi. The overall rating for this plan is not yet available for 2025.
It's important to know that Shared Health Dual Freedom (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Shared Health Dual Freedom (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Shared Health Dual Freedom (PPO D-SNP).
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 Shared Health Dual Freedom (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $47.30. 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 $590.00 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 $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
The Shared Health Dual Freedom (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy, the plan's premium is $47.30. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs. Please check the plan’s formulary for specific drugs covered and their associated costs.
Additional Benefits
The Shared Health Dual Freedom (PPO D-SNP) plan covers a wide range of services with varying cost-sharing. Inpatient hospital stays have a $1950 copay, while outpatient, emergency, and urgent care services have a 20% coinsurance. The plan also offers benefits for vision, dental, and hearing services with copays or coinsurance depending on the specific service. The plan also includes coverage for home health, preventive services, and medical equipment. Home health services have no copay, and the plan covers a range of other services like acupuncture and OTC items with coinsurance or monthly allowances. Certain services like skilled nursing facilities and home infusion require prior authorization and have specific cost-sharing structures.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered and require prior authorization, with a copay of $1950 for a Medicare-covered stay. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services also have a 20% coinsurance. Outpatient substance abuse services, including individual and group sessions, also have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Shared Health Dual Freedom (PPO D-SNP) plan, but requires prior authorization. The plan has a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services with a 20% coinsurance, but transportation services to any health-related location are not covered. Transportation services to a plan-approved health-related location are covered.
Emergency Services See details
Emergency Services are covered by the Shared Health Dual Freedom (PPO D-SNP) plan with a 20% coinsurance, and no copay. Urgently Needed Services are also covered with a 20% coinsurance and no copay, but Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. For Primary Care Physician Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services, there is a 20% coinsurance. Chiropractic Services, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services all have a 20% coinsurance. Occupational Therapy Services have a 20% coinsurance, and prior authorization is required.
Preventive Services See details
The Shared Health Dual Freedom (PPO D-SNP) plan covers preventive services, including Medicare-covered services with no copay. Kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are covered with a 20% coinsurance. The plan does not cover annual physical exams, health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing Services include hearing exams with a coinsurance of at most 20% and 1 routine hearing exam annually. Fitting/Evaluation for Hearing Aid benefits are covered, while Prescription Hearing Aids are covered with a maximum of 2 per ear every three years, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams and eyewear. Routine eye exams have a 20% coinsurance with one exam covered every year, and eyewear has a 20% coinsurance with a $300 allowance per year for glasses and/or contact lenses and fittings.
Dental Services See details
Dental Services are covered, with a maximum benefit of $3,000 per year for in-network services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered, but adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
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. For Medicare Part B Insulin Drugs, there is a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Shared Health Dual Freedom (PPO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Shared Health Dual Freedom (PPO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance and no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance and no copay, while medical supplies have a 20% coinsurance and no copay. Diabetic equipment has a 20% coinsurance for covered services with no copay, including both diabetic supplies and diabetic therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Shared Health Dual Freedom (PPO D-SNP) plan with no copay and no coinsurance, but authorization is required. 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 any of the sub-services, including 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. There is coinsurance for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Shared Health Dual Freedom (PPO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, but for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Shared Health Dual Freedom (PPO D-SNP) plan covers acupuncture with 20% coinsurance, and over-the-counter (OTC) items with a maximum benefit of $190 per month. The plan also provides a meal benefit with 14 meals following an acute inpatient or SNF discharge stay to a home setting. However, other services such as Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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