Freedom (HMO)
Get lower out of pocket costs and coverage recognized nationwide.
standard
Freedom (HMO)
standard
Get lower out of pocket costs and coverage recognized nationwide.
PRIMARY/SPECIALTY
$5/$45
DRUG DEDUCTIBLES
INPATIENT HOSPITAL
$290 per day for days 1-7, $2,030 OOP Max per year
Freedom (HMO) Plan Details
Primary Care Doctor/Specialist
| Primary Care Doctor | Specialist |
|---|---|
| $5 | $45 |
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 | N/A |
| Part D Prescriptions: | Preferred Pharmacy | Standard Pharmacy |
|---|---|---|
| Tier 1 | N/A | N/A |
| Tier 2 | N/A | N/A |
| Tier 3 | N/A | N/A |
| Tier 4 | N/A | N/A |
| Tier 5 | N/A | N/A |
Surgery & Treatment
| Inpatient hospital | $290 per day for days 1-7, $2,030 OOP Max per year |
| Outpatient hospital | $325 |
| Ambulatory surgery | $225 |
| X-rays | $45 |
| Advanced radiology | $150 |
| Lab copayment | $0 |
Preventive Dental
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 | |
|---|---|---|---|
| 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)* | $699 or $999/unit |
| In-network out-of-pocket maximum | $5,000 |
**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.
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
Explore Medicare
*If you need a different format, please view our Multi-Language Interpreter Services.
Highmark Blue Shield of Northeastern New York (BSNENY) is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal. 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)
Y0086_MRK2926
Content last updated: March 6, 2021