Freedom Basic (PPO)
NEW! Enjoy comprehensive medical and drug coverage, additional benefits, and get $50 back every month. This unique benefit comes with our Freedom Basic (PPO) plan and puts $50 back in your Social Security check every month.*
basic
Freedom Basic (PPO)
basic
Enjoy comprehensive medical and drug coverage, additional benefits, and get $50 back every month.
PRIMARY/SPECIALTY
$15/$46
DRUG DEDUCTIBLES
$0 Tiers 1–2; $350 Tiers 3–5
INPATIENT HOSPITAL
$400 per day for days 1-5, $2,000 OOP Max per year
Freedom Basic (PPO) Plan Details
Primary Care Doctor/Specialist
| Primary Care Doctor | Specialist |
|---|---|
| $15 | $46 |
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.
Part D Prescription Drugs
| Drug Deductibles | $0 Tiers 1-2; $350 Tiers 3-5 |
| Part D Prescriptions: | Preferred Pharmacy | Standard Pharmacy |
|---|---|---|
| Tier 1 | $2 | $7 |
| Tier 2 | $14 | $19 |
| Tier 3 | $42 | $47 |
| Tier 4 | $94 | $100 |
| Tier 5 | 27% | 27% |
$0 Tier 1 Generics with Convenient Home Delivery
$0 copay for a 90-day supply of Tier 1 preferred generic medications delivered for free through Express Scripts® mail order during the initial coverage stage.
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 Information
The 2022 Medicare Formulary includes a list of prescription care drugs covered by a prescription drug plan.
Surgery & Treatment
| Inpatient hospital | $400/day, days 1-4; $2,000 OOP max per year |
| Outpatient hospital | $475 |
| Ambulatory surgery | $425 |
| X-rays | $50 |
| Advanced radiology | $200 |
| Lab copayment | $10 |
Preventive Dental
All our plans include preventive dental coverage:
- Routine cleanings/oral exams - once 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 | |
|---|---|---|---|
| Basic | $13 | 50% coinsurance | $500 |
| Enhanced | $24 | 50% coinsurance | $1,000 |
Note: Preventive services do not count toward the annual max allowance for dental.
Plan Highlights
| 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 | $188/day |
| Hearing aid (specific models) | Not Covered |
| In-network out-of-pocket maximum | $7,550 |
| Combined in and out-of-network maximum | $11,300 |
*$0 Part B diabetic monitoring supplies including lancets, glucose monitors, and test strips
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.
Medicare Questions?
We're here to help.
1-833-735-4512 (TTY 711)
Oct. 1 - March 31, 8 a.m. - 8 p.m., 7 days a week
April 1 - Sept. 30, 8 a.m. - 8 p.m., Monday - Friday
Frequently Asked Questions
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*Beneficiaries are eligible for a Part B monthly premium giveback if they do not receive Medicaid or anyother assistance paying their Part B premium. Beneficiaries must continue paying their Part B premium.
*If you need a different format, please view our Multi-Language Interpreter Services.
Highmark Blue Shield of Northeastern New York (Highmark BSNENY) is a trade name of Highmark Western and Northeastern New York Inc., an independent licensee of the Blue Cross Blue Shield Association. Highmark BSNENY is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal. Highmark 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).
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Content last updated: October 1, 2021