2023 Blue Medicare Freedom+ (PPO)

Blue Medicare Freedom+ (PPO) H3404-004 is a 2023 Medicare Advantage Plan or Part-C by Blue Cross and Blue Shield of North Carolina available to residents in North Carolina. This plan does not provide extra prescription drug (Part-D) coverage. Blue Cross and Blue Shield of North Carolina Blue Medicare Freedom+ (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $8,300 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $8,300 out-of-pocket. This can be an extremely nice safety net.

Blue Cross and Blue Shield of North Carolina works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Blue Medicare Freedom+ (PPO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Blue Cross and Blue Shield of North Carolina and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Blue Cross and Blue Shield of North Carolina except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in North Carolina.

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Benefits
Monthly Costs
MOOP
Reviews
Coverage Area

2023 Blue Cross and Blue Shield of North Carolina Medicare Advantage Plan Overview

Name:	Blue Medicare Freedom+ (PPO)
Plan ID:	H3404 004 0
Provider:	Blue Cross and Blue Shield of North Carolina
Year:	2023
Type:	Local PPO *
Combined Premium (C+D):	$0/mo
MOOP:	$8,300/yr
Similar Plan:	H3404-003

What type of plan is Blue Medicare Freedom+ (PPO)

Blue Medicare Freedom+ (PPO) is a Local PPO *. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network, but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

How much does Blue Medicare Freedom+ (PPO) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Blue Cross and Blue Shield of North Carolina charges a $0 premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Blue Medicare Freedom+ (PPO) by Blue Cross and Blue Shield of North Carolina MOOP is $8,300. Once you spend $8,300 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.

2023 Summary of Benefits

The benefit information provided is a summary of what Blue Medicare Freedom+ (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Blue Cross and Blue Shield of North Carolina helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)	Covered

Contact lenses

Vision	Not covered

Eyeglass frames

Vision	Not covered

Eyeglass lenses

Vision	Not covered

Eyeglasses (frames and lenses)

Vision	Not covered

Other

Vision	Not covered

Routine eye exam

Vision	Not covered

Upgrades

Vision	Not covered

In-Network Transportation	$0 copay
Out-of-Network Transportation	$0 copay
In-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $196 per day for days 21 through 60 $0 per day for days 61 through 100
Out-of-Network Skilled Nursing Facility	40% per day for days 1 through 100

Occupational therapy visit

In-Network Rehabilitation services	$40 copay
Out-of-Network Rehabilitation services	40% coinsurance

Physical therapy and speech and language therapy visit

In-Network Rehabilitation services	$40 copay
Out-of-Network Rehabilitation services	40% coinsurance

Cleaning

Preventive dental	Not covered

Dental x-ray(s)

Preventive dental	Not covered

Fluoride treatment

Preventive dental	Not covered

Oral exam

Preventive dental	Not covered

In-Network Preventive care	$0 copay
Out-of-Network Preventive care	$0 copay
In-Network Outpatient hospital coverage	20% coinsurance per visit
Out-of-Network Outpatient hospital coverage	40% coinsurance per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

Inpatient hospital - psychiatric

In-Network Mental health services	$1,871 per stay
Out-of-Network Mental health services	40% per day for days 1 through 190

Outpatient group therapy visit

In-Network Mental health services	20% coinsurance
Out-of-Network Mental health services	40% coinsurance

Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	20% coinsurance
Out-of-Network Mental health services	40% coinsurance

Outpatient individual therapy visit

Out-of-Network Mental health services	40% coinsurance
In-Network Mental health services	20% coinsurance

Outpatient individual therapy visit with a psychiatrist

Out-of-Network Mental health services	40% coinsurance
In-Network Mental health services	20% coinsurance

Chemotherapy

Out-of-Network Medicare Part B drugs	40% coinsurance
In-Network Medicare Part B drugs	20% coinsurance

Other Part B drugs

Out-of-Network Medicare Part B drugs	40% coinsurance
In-Network Medicare Part B drugs	20% coinsurance

Diabetes supplies

Out-of-Network Medical equipment/supplies	40% coinsurance per item
In-Network Medical equipment/supplies	20% coinsurance per item

Durable medical equipment (e.g., wheelchairs, oxygen)

In-Network Medical equipment/supplies	20% coinsurance per item
Out-of-Network Medical equipment/supplies	40% coinsurance per item

Prosthetics (e.g., braces, artificial limbs)

In-Network Medical equipment/supplies	20% coinsurance per item
Out-of-Network Medical equipment/supplies	40% coinsurance per item

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$12,450 In and Out-of-network $8,300 In-network
Out-of-Network Inpatient hospital coverage	40% per day for days 1 and beyond
In-Network Inpatient hospital coverage	$2,050 per stay

Fitting/evaluation

Hearing	Not covered

Hearing aids - inner ear

Hearing	Not covered

Hearing aids - outer ear

Hearing	Not covered

Hearing aids - over the ear

Hearing	Not covered

Hearing exam

In-Network Hearing	20% coinsurance
Out-of-Network Hearing	40% coinsurance

Health plan deductible	$0
Out-of-Network Ground ambulance	40% coinsurance
In-Network Ground ambulance	20% coinsurance

Foot exams and treatment

In-Network Foot care (podiatry services)	20% coinsurance
Out-of-Network Foot care (podiatry services)	40% coinsurance

Routine foot care

Foot care (podiatry services)	Not covered

Emergency

Emergency care/Urgent care	$95 copay per visit (always covered)

Urgent care

Emergency care/Urgent care	$60 copay per visit (always covered)

Primary

Out-of-Network Doctor visits	40% coinsurance per visit
In-Network Doctor visits	20% coinsurance per visit

Specialist

In-Network Doctor visits	20% coinsurance per visit
Out-of-Network Doctor visits	40% coinsurance per visit

Diagnostic radiology services (e.g., MRI)

In-Network Diagnostic procedures/lab services/imaging	20% coinsurance
Out-of-Network Diagnostic procedures/lab services/imaging	40% coinsurance

Diagnostic tests and procedures

Out-of-Network Diagnostic procedures/lab services/imaging	40% coinsurance
In-Network Diagnostic procedures/lab services/imaging	20% coinsurance

Lab services

Out-of-Network Diagnostic procedures/lab services/imaging	40% coinsurance
In-Network Diagnostic procedures/lab services/imaging	20% coinsurance

Outpatient x-rays

Out-of-Network Diagnostic procedures/lab services/imaging	40% coinsurance
In-Network Diagnostic procedures/lab services/imaging	20% coinsurance

Diagnostic services

Comprehensive dental	Not covered

Endodontics

Comprehensive dental	Not covered

Extractions

Comprehensive dental	Not covered

Non-routine services

Comprehensive dental	Not covered

Periodontics

Comprehensive dental	Not covered

Prosthodontics, other oral/maxillofacial surgery, other services

Comprehensive dental	Not covered

Restorative services

Comprehensive dental	Not covered

In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	No

Blue Medicare Freedom+ (PPO) Reviews

Is Blue Medicare Freedom+ (PPO) a good plan? Blue Medicare Freedom+ (PPO) received a 4.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare Blue Medicare Freedom Reviews among several different plans.

2022 Overall Rating
Part C Summary Rating
Part-D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with H3404-004 Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement

Health Plan Customer Service Rating for Blue Cross and Blue Shield of North Carolina

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Blue Medicare Freedom+ (PPO) requires you to live in that plan’s service area. The service area is listed below:

State:	North Carolina Medicare

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How much does Blue Medicare Freedom+ (PPO) cost?

Blue Cross and Blue Shield of North Carolina charges a $0 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Blue Medicare Freedom+ (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Blue Medicare Freedom+ (PPO) by Blue Cross and Blue Shield of North Carolina MOOP is $8,300. Once you spend $8,300 you will pay nothing for Part A or Part B covered services.

What type of plan is Blue Medicare Freedom+ (PPO)?

Blue Medicare Freedom+ (PPO) is a Local PPO *. A (PPO) is a Medicare plan that has contracts with a network of preferred providers. You do not need to select a primary care physician and you do not need referrals to see other providers in the network.

Is Blue Medicare Freedom+ (PPO) a good plan?

Blue Medicare Freedom+ (PPO) received a 4.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.

Source:CMS. Data as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.