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BlueAdvantage Freedom (PPO)

H7917 - 039 - 0
4.5 out of 5 stars (4.5 / 5)

BlueAdvantage Freedom (PPO) is a Medicare Advantage Plan by BlueCross BlueShield of Tennessee.

This page features plan details for 2025 BlueAdvantage Freedom (PPO) H7917 – 039 – 0 available in Statewide Tennessee + Northwest GA.

Locations

BlueAdvantage Freedom (PPO) is offered in the following locations.

Anderson County, Tennessee
Bedford County, Tennessee
Benton County, Tennessee

Click to see more locations

Plan Overview

BlueAdvantage Freedom (PPO) offers the following coverage and cost-sharing.

Insurer:BlueCross BlueShield of Tennessee
Health Plan Deductible:$0
MOOP:$5,750 In and Out-of-network
$3,200 In-network
Drugs Covered:No

Ready to sign up for BlueAdvantage Freedom (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

BlueAdvantage Freedom (PPO) qualifies for a monthly Medicare Give Back Benefit of $40.00.

Premium Reduction:$40.00

Premium Breakdown

BlueAdvantage Freedom (PPO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$185.00 $0.00 $40.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

BlueAdvantage Freedom (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Endodontics
    • In-Network: No Coins – No Co pay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Implant Services
    • In-Network: 20 Coins – No Co pay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Oral and Maxillofacial Surgery
    • In-Network: 20 Coins – No Co pay (Limits Apply, Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply, Authorization Required)
  • Periodontics
    • In-Network: No Coins – No Co pay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Prosthodontics, fixed
    • In-Network: 20 Coins – No Co pay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Prosthodontics, removable
    • In-Network: 20 Coins – No Co pay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Restorative Services
    • In-Network: 20 Coins – No Co pay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay
  • Fluoride Treatment
    • In-Network: No Coins – No Copay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Oral Exams
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay
  • Other Diagnostic Dental Services
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Other Preventive Dental Services
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic tests and procedures
    • In-Network: $0-35 copay (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Lab services
    • In-Network: $0-30 copay or 20% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Lab services
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Outpatient x-rays
    • In-Network: $0-35 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $110 copay (Authorization Required)
  • Outpatient x-rays
    • Out-of-Network: 50% coinsurance (Authorization Required)

Doctor visits

  • Specialist
    • In-Network: $25 copay per visit
  • Primary
    • In-Network: $0 copay
    • Out-of-Network: $10 copay per visit
  • Specialist
    • Out-of-Network: $30 copay per visit

Emergency care/Urgent care

  • Urgent care
    • $25 copay per visit (always covered)
  • Emergency
    • $140 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $25 copay
    • Out-of-Network: 50% coinsurance
  • Routine foot care
    • In-Network: $25 copay (Limits Apply)

Ground ambulance

    • Out-of-Network: $250 copay
    • In-Network: $250 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • In-Network: $0 copay
  • Medicare-Covered Hearing Exam
    • In-Network: $10 copay
  • Fitting/evaluation
    • Out-of-Network: $0 copay
  • Hearing aids OTC
    • Not covered
  • Hearing aids
    • In-Network: $199-699 copay (Limits Apply)
    • Out-of-Network: $199-699 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • Out-of-Network: $10 copay

Inpatient hospital coverage

    • Out-of-Network: $225 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
    • In-Network: $175 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $5,750 In and Out-of-network
      $3,200 In-network

Medical equipment/supplies

  • Diabetes supplies
    • Out-of-Network: 50% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • In-Network: 0-20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 50% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 50% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Chemotherapy
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • In-Network: $175 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Outpatient group therapy visit
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $15 copay (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: $25 copay (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $25 copay (Authorization Required)
  • Inpatient hospital – psychiatric
    • Out-of-Network: $225 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $15 copay (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: 50% coinsurance (Authorization Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $175 copay per visit (Authorization Required)
    • Out-of-Network: $225 copay per visit (Authorization Required)

Preventive care

    • In-Network: $0 copay
    • Out-of-Network: 50% coinsurance

Rehabilitation services

  • Occupational therapy visit
    • In-Network: $25 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Occupational therapy visit
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • In-Network: $25 copay (Authorization Required)

Skilled Nursing Facility

    • In-Network: $0 per day for days 1 through 20
      $214 per day for days 21 through 100 (Authorization Required)
    • Out-of-Network: 50% per stay (Authorization Required)

Transportation

    • Not covered

Vision

  • Eyeglass frames
    • Not covered
  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Other
    • Not covered
  • Routine eye exam
    • Out-of-Network: $0 copay (Limits Apply)
  • Upgrades
    • Not covered
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Not covered
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for BlueAdvantage Freedom (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on BlueAdvantage Freedom (PPO)? See 2025 BlueAdvantage Freedom (PPO) at MedicareAdvantageRX.com.

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Get Help Enrolling

Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint

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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

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We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.

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