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Freedom (HMO)

Get lower out of pocket costs and coverage recognized nationwide.

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Freedom (HMO)

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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

MONTHLY PREMIUM

$0

MONTHLY PREMIUM

$0

Freedom (HMO) Plan Details

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Primary Care Doctor/Specialist

Primary Care Doctor Specialist
$5 $45
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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. 

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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
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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
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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.

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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

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

*If you need a different format, please view our Multi-Language Interpreter Services.

BlueShield 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)

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Content last updated: March 6, 2021