2027 Medicare Advantage plan
BlueAdvantage Freedom (PPO): 2027 benefits and costs
BlueCross BlueShield of Tennessee PPO
CMS plan ID: H7917-039-0 · Plan year: 2027
BlueAdvantage Freedom (PPO) is a 2027 Medicare Advantage plan offered by BlueCross BlueShield of Tennessee. It is listed in Georgia, Tennessee.
2027 plan costs at a glance
Monthly plan premium$0.00
In-network medical out-of-pocket maximum$4,450.00
- Organization
- BlueCross BlueShield of Tennessee
- Plan organization
- BLUECROSS BLUESHIELD OF TENNESSEE, INC.
- Parent company
- BlueCross BlueShield of Tennessee
- Plan type
- PPO
- Part C premium
- $0.00
- Prescription drug coverage
- No
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
- Monthly Part B premium after plan reduction
- $139.50 (estimated)$209.50 standard premium less $70.00 plan reduction.
You must continue to pay your Medicare Part B premium.
- Annual medical deductible
- None
- In-network medical maximum
- $4,450.00
- Combined in/out-of-network medical maximum
- $6,700.00
- Out-of-network medical maximum
- Not applicable
- Part B premium reduction
- $70.00
2027 benefit summary
Doctor visits and medical care
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Primary care doctor | $0
| 50% coinsurance
| |
| Specialist visit | $30.00 copay
| 50% coinsurance
|
|
| Telehealth | $0
| Not summarized. Check coverage with the plan. |
|
| Emergency care | $150.00 copay | Not summarized. Check coverage with the plan. | |
| Urgent care | $45.00 copay | Not summarized. Check coverage with the plan. | |
| Home health | $0
| 50% coinsurance
|
|
| Dialysis | 20% coinsurance
| 20% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
| 50% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
| 50% coinsurance
|
|
| Kidney disease education services | $0
| 50% coinsurance
|
|
| Medicare-covered chiropractic | $20.00 copay
| 50% coinsurance
|
|
| Medicare-covered foot care | $30.00 copay
| 50% coinsurance
|
|
| Other health professionals | $20.00 to $30.00 copay
| 50% coinsurance
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–5: $225.00 copay per day Days 6–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–5: $225.00 copay per day Days 6–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Outpatient hospital care | $275.00 copay
| 50% coinsurance
| |
| Hospital observation services | $200.00 copay
| 50% coinsurance
| |
| Ambulatory surgical center | $125.00 copay
| 50% coinsurance
|
|
| Outpatient blood | $0
| $0
|
|
Tests, imaging and laboratory services
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Diagnostic procedures and tests | $0.00 to $35.00 copay
| 50% coinsurance
|
|
| Laboratory services | $0.00 to $30.00 copay; 20% coinsurance
| 50% coinsurance
|
|
| Diagnostic radiology (CT, MRI) | $110.00 copay
| 50% coinsurance
|
|
| Therapeutic radiology | 20% coinsurance
| 50% coinsurance
|
|
| X-rays | $0.00 to $35.00 copay
| 50% coinsurance
|
|
Mental health and substance use treatment
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Partial hospitalization | $40.00 copay
| 50% coinsurance
|
|
| Intensive outpatient program | $40.00 copay
| 50% coinsurance
|
|
| Substance use treatment, individual sessions | $25.00 copay
| 50% coinsurance
|
|
| Substance use treatment, group sessions | $15.00 copay
| 50% coinsurance
|
|
| Opioid treatment program | $0
| 50% coinsurance
|
|
| Mental health, individual sessions | $25.00 copay
| 50% coinsurance
|
|
| Mental health, group sessions | $15.00 copay
| 50% coinsurance
|
|
| Psychiatry, individual sessions | $25.00 copay
| 50% coinsurance
|
|
| Psychiatry, group sessions | $15.00 copay
| 50% coinsurance
|
|
Therapy and rehabilitation
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Occupational therapy | $25.00 copay
| 50% coinsurance
|
|
| Physical and speech therapy | $25.00 copay
| 50% coinsurance
|
|
| Cardiac rehabilitation | $0
| 50% coinsurance
|
|
| Intensive cardiac rehabilitation | $0
| 50% coinsurance
|
|
| Pulmonary rehabilitation | $15.00 copay
| 50% coinsurance
|
|
| Supervised exercise for peripheral artery disease | $10.00 copay
| 50% coinsurance
|
|
Ambulance, medical equipment and supplies
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Ground ambulance | $250.00 copay
| $250.00 copay
|
|
| Air ambulance | 20% coinsurance
| 20% coinsurance
|
|
| Durable medical equipment | 20% coinsurance
| 50% coinsurance
|
|
| Prosthetic devices | 20% coinsurance
| 50% coinsurance
|
|
| Medical supplies | 20% coinsurance
| 50% coinsurance
|
|
| Diabetic supplies | $0
| 50% coinsurance
|
|
| Diabetic shoes and inserts | $10.00 copay
| 50% coinsurance
|
|
| Diabetic monitors | 20% coinsurance
| 50% coinsurance
|
|
Dental benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered dental | $30.00 copay | 50% coinsurance
| |
| Oral examsAdditional plan benefit | $0 | 50% coinsurance
| |
| Dental X-raysAdditional plan benefit | $0 | 50% coinsurance
| |
| Dental cleaningAdditional plan benefit | $0 | 50% coinsurance
| |
| Restorative dental careAdditional plan benefit | 20% coinsurance | 50% coinsurance
| |
| Root canal treatment (endodontics)Additional plan benefit | $0 | 50% coinsurance
| |
| Gum treatment (periodontics)Additional plan benefit | $0 | 50% coinsurance
| |
| Removable dentures (prosthodontics)Additional plan benefit | 20% coinsurance | 50% coinsurance
| |
| Fixed dental restorations (prosthodontics)Additional plan benefit | 20% coinsurance | 50% coinsurance
| |
| Oral surgeryAdditional plan benefit | 20% coinsurance | 50% coinsurance
| |
| Other dental servicesAdditional plan benefit | 20% coinsurance | 50% coinsurance
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Diagnostic and preventive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Comprehensive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Vision benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered eye exams | $0
| $0
|
|
| Routine eye examsAdditional plan benefit | $0 | $0
|
|
| Medicare-covered eyewear | $0
| $0
|
|
| Contact lensesAdditional plan benefit | $0 | $0
|
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0 | $0
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Eye exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Eyewear (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Hearing benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered hearing exams | $10.00 copay
| $10.00 copay
|
|
| Routine hearing examsAdditional plan benefit | $0 | 90% coinsurance
|
|
| Hearing aid fitting and evaluationAdditional plan benefit | $0 | 90% coinsurance
|
|
| Prescription hearing aids (all types)Additional plan benefit | $199.00 to $699.00 copay
| 90% coinsurance
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Hearing exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Prescription hearing aids (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Extra benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Over-the-counter health itemsAdditional plan benefit | $0
| 80% coinsurance
| |
| Limited-duration mealsAdditional plan benefit | $0
| 80% coinsurance
|
|
| Annual physical examAdditional plan benefit | $0
| 50% coinsurance
|
|
| Fitness benefitAdditional plan benefit | $0
| 80% coinsurance
|
|
Additional services and network costs
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Podiatry Services - Routine Foot CareAdditional plan benefit | Out-of-network | 50% coinsurance
|
|
| Medicare-covered preventive servicesMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Enhanced Disease ManagementAdditional plan benefit | Out-of-network | $0
|
|
| Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Additional plan benefit | Out-of-network | $0
|
|
| Glaucoma ScreeningMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Diabetes Self-Management TrainingMedicare-covered care | Out-of-network | 20% coinsurance
| |
| Digital Rectal ExamsMedicare-covered care | Out-of-network | 50% coinsurance
| |
| EKG after a Welcome to Medicare visitMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Medicare Part B insulinMedicare-covered care | Out-of-network | $35.00 copay
|
Prescription drug coverage
This plan does not include a Part D prescription drug benefit.
Where this plan is offered
CMS lists this plan in 2 states or territories. Availability can vary by county and ZIP code.
View all locations 98 county listings across 2 states or territories
Georgia
Tennessee
- Anderson, Tennessee
- Bedford, Tennessee
- Benton, Tennessee
- Bledsoe, Tennessee
- Blount, Tennessee
- Bradley, Tennessee
- Campbell, Tennessee
- Cannon, Tennessee
- Carroll, Tennessee
- Carter, Tennessee
- Cheatham, Tennessee
- Chester, Tennessee
- Claiborne, Tennessee
- Clay, Tennessee
- Cocke, Tennessee
- Coffee, Tennessee
- Crockett, Tennessee
- Cumberland, Tennessee
- Davidson, Tennessee
- Decatur, Tennessee
- DeKalb, Tennessee
- Dickson, Tennessee
- Dyer, Tennessee
- Fayette, Tennessee
- Fentress, Tennessee
- Franklin, Tennessee
- Gibson, Tennessee
- Giles, Tennessee
- Grainger, Tennessee
- Greene, Tennessee
- Grundy, Tennessee
- Hamblen, Tennessee
- Hamilton, Tennessee
- Hancock, Tennessee
- Hardeman, Tennessee
- Hardin, Tennessee
- Hawkins, Tennessee
- Haywood, Tennessee
- Henderson, Tennessee
- Henry, Tennessee
- Hickman, Tennessee
- Houston, Tennessee
- Humphreys, Tennessee
- Jackson, Tennessee
- Jefferson, Tennessee
- Johnson, Tennessee
- Knox, Tennessee
- Lake, Tennessee
- Lauderdale, Tennessee
- Lawrence, Tennessee
- Lewis, Tennessee
- Lincoln, Tennessee
- Loudon, Tennessee
- Macon, Tennessee
- Madison, Tennessee
- Marion, Tennessee
- Marshall, Tennessee
- Maury, Tennessee
- McMinn, Tennessee
- McNairy, Tennessee
- Meigs, Tennessee
- Monroe, Tennessee
- Montgomery, Tennessee
- Moore, Tennessee
- Morgan, Tennessee
- Obion, Tennessee
- Overton, Tennessee
- Perry, Tennessee
- Pickett, Tennessee
- Polk, Tennessee
- Putnam, Tennessee
- Rhea, Tennessee
- Roane, Tennessee
- Robertson, Tennessee
- Rutherford, Tennessee
- Scott, Tennessee
- Sequatchie, Tennessee
- Sevier, Tennessee
- Shelby, Tennessee
- Smith, Tennessee
- Stewart, Tennessee
- Sullivan, Tennessee
- Sumner, Tennessee
- Tipton, Tennessee
- Trousdale, Tennessee
- Unicoi, Tennessee
- Union, Tennessee
- Van Buren, Tennessee
- Warren, Tennessee
- Washington, Tennessee
- Wayne, Tennessee
- Weakley, Tennessee
- White, Tennessee
- Williamson, Tennessee
- Wilson, Tennessee