Freedom Value (HMO)
New for 2020! New Blue Total Health Package
Live a healthy lifestyle with our additional BlueShield benefits and preventive services included in your Medicare Advantage plan.
|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.
|Drug Deductibles||$0 Tiers 1 - 2; $350 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.
Prescription Drug Infomation
The 2020 Medicare Formulary includes a list of prescription care drugs covered by a prescription drug plan.
Surgery & Treatment
|Inpatient hospital||$370 per day, days 1-5 / $1,850 out-of-pocket max per year|
All our plans include preventive dental coverage:
- Routine cleanings/oral exams - twice per year ($15 copay per service).
- X-rays - four bitewing or one full-month X-ray per year ($15 copay per service).
Optional Supplemental Dental is also available:
You may add Dental Care with the following optional supplemental benefits (no network - see any dentist):
|Premium||Diagnostic and Restorative Service Cost||Annual Max Allowance|
Note: Preventive services do not count toward the annual max allowance for dental.
|World coverage for emergency and urgent care||$90/$65|
|Part B diabetes supplies and monitors||$0|
|Skilled nursing facility days 1-20||$0|
|Skilled nursing facility days 21-100||$178.00/day|
|Hearing aid (specific models)*||$699 or $999/unit|
|In-network out-of-pocket maximum||$6,700|
*Our plans cover one routine hearing exam per year with a TruHearing® provider. 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).
This past January, the Centers for Medicare & Medicaid Services (CMS) added acupuncture as a covered benefit for Medicare patients with chronic low back pain. According to CMS, coverage will include "up to 12 sessions in 90 days with an additional 8 sessions for those patients with chronic low back pain who demonstrate improvement." Treatment must also be recommended and supervised by a doctor.
New Blue Total Health Package
Our Blue Total Health package provides you with the additional benefits and preventive services you want and need to help you live a healthy lifestyle. This exclusive benefits package includes:
Preventive dental coverage includes reimbursement for up to two cleanings, two exams, and one set of X-rays annually1. This benefit requires no network and can be used at any dental provider.
- $15 copay per service
Up to $100 annual allowance for over-the-counter drugs and supplies with convenient home delivery. Choose from hundreds of items from an online shop or catalog including vitamins, allergy care, first aid and supports and braces.2
- $100 annual allowance on frames, lenses, and contacts through an EyeMed provider
- $25 annual routine eye exam through an EyeMed provider
Save thousands on hearing aids through TruHearing.
- $699 or $999 per unit4
- $45 annual routine hearing exam through a TruHearing provider
SilverSneakers® no-cost fitness benefit with access to 16,000+ fitness locations nationwide.
Rewards for preventive services
Earn up to $60 for annual preventive services including annual wellness visit, colon cancer screening, and breast cancer screening.5 Up to $60 total or one $20 Prepaid Card per service.
Low- or no-cost vaccines
- $0 copay for preventive vaccines including flu, pneumonia, and hepatitis
- Coverage for shingles vaccine with Tier 1 copay (copay varies by plan)
Part B diabetic monitoring supplies
- $0 Part B diabetic monitoring supplies including lancets, glucose monitors, and test strips
Unless otherwise noted, costs shown are for services received in-network.
1. Preventive cleanings do not include periodontal cleanings (commonly referred to by dentists as deep cleaning or scaling and root planing)
2. $25 allowance per quarter up to $100 annually. Limit of one order per quarter. OTC drugs are obtained through online, mail-in order form, or by phone and delivered to the member's home.
3. In order for your service to be in-network you must see an EyeMed participating provider.
4. Our plans cover one routine hearing exam per year with a TruHearing® provider. Please call TruHearing to verify your benefit and schedule a hearing exam. Coverage is for select models only.
5. Annual wellness visit, breast cancer screening, and colon cancer screening are covered by any doctor in our network as part of your member benefits. If other services are performed by your doctor at the same visit, you may have a higher copay.
Contracts and Additional Resources
Looking for another plan?
BlueShield of Northeastern New York (BSNENY) is a division of HealthNow New York Inc., an independent licensee of the Blue Cross and Blue Shield Association. BSNENY 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 15, 2019.