Freedom Premier (HMO-POS)
Our Freedom Premier (HMO-POS) plan offers enhanced out-of-network coverage, providing you with the flexibility to see out-of-network doctors and specialist for most services, including specialist visits, x-rays, diagnostic tests and procedures, inpatient hospital stays, and outpatient surgery, with an annual out-of-network limit of $25,000.
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|Primary Care Doctor||Specialist|
Use our new Find a Doctor tool to discover if your doctor, specialist, or facility are in-network.
If they are not in-network, you can search to find one that is in our network of providers.
Out-of-network coverage: Point of Service (POS): You pay a $36 copay for specialists, $5 copay for labs, and up to 50% for most remaining covered services (BlueShield pays up to $25,000 per year).
|Drug Deductibles||$0 Tiers 1-2; $100 Tiers 3-5|
|Part D Prescriptions:||Preferred Pharmacy||Standard Pharmacy|
The Medicare Part D Coverage Gap
The 'coverage gap' or 'donut hole' is a Part D drug coverage stage that changes what you pay for prescriptions. You may not end up in the coverage gap each year, but you should be aware of how it works. Our plans cover Tier 1 generics through the gap, so you would pay a copay for those drugs.
Surgery and Treatment
|Inpatient hospital||$295/day, days 1-4; $1,180 max out-of-pocket per year|
Optional Supplemental Dental Care
Optional supplemental benefits (no network - see any dentist)
|Premium||Preventive Services (2 cleanings & 2 oral exams/year)||Diagnostic and Restorative Service Cost||Annual Max Allowance|
|Basic||$19||50% coinsurance||50% coinsurance||$500|
|Enhanced||$38||Full coverage||50% coinsurance||$1,000|
|Worldwide coverage for emergency and urgent care||$90 Emergency care; $65 Urgent care|
|Part B diabetes supplies and monitors||$0|
|Skilled nursing facility days 1-20||$0|
|Skilled nursing facility days 21-100||$172.00/day|
|Hearing aid (specific models)*||$699 or $999/unit|
|In-network out-of-pocket maximum||$5,500|
*Our plans cover one routine hearing exam per year with a TruHearing® provider. Cost shares may apply. Please call TruHearing to verify your benefit and schedule a hearing exam. Hearing aid $699 or $999/unit (one per ear, per year, specific models).
New! Up to $60 in Rewards:
You can earn a $20 reward card (up to $60) each after receiving certain preventive services, including your annual wellness visit, colorectal cancer screening, and breast cancer screening (subject to medical necessity).
Free Preventive Services:
More than 20 services are included at no cost* when you use providers in our network. These services include annual wellness visit, bone density test, cardiovascular screenings, cancer screenings, diabetes self-management training, vaccines, and more.
- Explore services offered at $0 copay
*A $0 copay applies when using an in-network provider.
Free Gym Membership:
Stay active with access to more than 14,000 fitness locations nationwide with SilverSneakers®. Enjoy amenities including weight machines, cardio equipment, swimming pools, saunas, exercise classes for all fitness levels, and more.
Medicare Advantage members now have access to Telemedicine hosted by Doctor On Demand. Connect with a doctor 24/7 using your mobile device, tablet, or computer for only $5 more than your primary doctor cost-share.
$0 Care Management:
Our nationally accredited care management team works with you and your doctor to help manage your health and meet your unique goals.
Care at HomeSM:
We've partnered with Landmark Health to create Care at Home℠ -- care and support available 24/7, provided in the comfort of your home.
Contracts and Additional Resources
Looking for another plan?
A division of HealthNow New York Inc., an independent licensee of the Blue Cross and Blue Shield Association. BlueShield of Northeastern New York is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal. This information is not a complete description of benefits. Call 1-800-329-2792 (TTY: 711) for more information. BlueShield of Northeastern New York complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-833-735-4515 (TTY: 711). 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-833-735-4515 (TTY: 711).
Content Last Updated October 1, 2018