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Vermont Blue Advantage Freedom PPO (PPO)

H6898 - 001 - 0
3.5 out of 5 stars (3.5 / 5)

Vermont Blue Advantage Freedom PPO (PPO) is a Medicare Advantage Plan by Vermont Blue Advantage.

This page features plan details for 2025 Vermont Blue Advantage Freedom PPO (PPO) H6898 – 001 – 0 available in State of Vermont.

Locations

Vermont Blue Advantage Freedom PPO (PPO) is offered in the following locations.

Addison County, Vermont
Bennington County, Vermont
Caledonia County, Vermont

Click to see more locations

Plan Overview

Vermont Blue Advantage Freedom PPO (PPO) offers the following coverage and cost-sharing.

Insurer:Vermont Blue Advantage
Health Plan Deductible:$0
MOOP:$7,750 In and Out-of-network
$6,000 In-network
Drugs Covered:Yes

Ready to sign up for Vermont Blue Advantage Freedom PPO (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

Premium Breakdown

Vermont Blue Advantage Freedom PPO (PPO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Vermont Blue Advantage Freedom PPO (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $250.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $250.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Vermont Blue Advantage Freedom PPO (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
    • Out-of-Network: No Coins – 0.00 Copay
  • Oral and Maxillofacial Surgery
    • In-Network: 0 Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – 0.00 Copay (Limits Apply)
  • Periodontics
    • In-Network: No Coins – No Co pay
    • Out-of-Network: No Coins – 0.00 Copay
  • Prosthodontics, fixed
    • In-Network: 0 Coins – No Co pay
    • Out-of-Network: No Coins – 0.00 Copay
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay
    • Out-of-Network: No Coins – 0.00 Copay
  • Restorative Services
    • In-Network: No Coins – No Co pay
    • Out-of-Network: No Coins – 0.00 Copay

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Fluoride Treatment
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Oral Exams
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – 0.00 Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-300 copay (Authorization Required)
    • Out-of-Network: $0-400 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $10 copay (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0-50 copay (Authorization Required)
  • Lab services
    • In-Network: $20 copay (Authorization Required)
  • Diagnostic tests and procedures
    • Out-of-Network: $0-70 copay (Authorization Required)
  • Lab services
    • Out-of-Network: $30 copay (Authorization Required)
  • Outpatient x-rays
    • Out-of-Network: $10 copay (Authorization Required)

Doctor visits

  • Primary
    • In-Network: $0 copay
    • Out-of-Network: $25 copay per visit
  • Specialist
    • In-Network: $55 copay per visit
    • Out-of-Network: $70 copay per visit

Emergency care/Urgent care

  • Emergency
    • $125 copay per visit (always covered)
  • Urgent care
    • $40 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $55 copay
    • Out-of-Network: $70 copay
  • Routine foot care
    • Not covered

Ground ambulance

    • Out-of-Network: $350 copay
    • In-Network: $350 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • Out-of-Network: $0 copay (Limits Apply)
  • Hearing aids
    • Out-of-Network: $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • Out-of-Network: $25-70 copay
  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • In-Network: $0-55 copay
  • Hearing aids OTC
    • Not covered
  • Hearing aids
    • In-Network: $0 copay (Limits Apply)

Inpatient hospital coverage

    • Out-of-Network: $600 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
    • In-Network: $450 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)

    • $7,750 In and Out-of-network
      $6,000 In-network

Medical equipment/supplies

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

Medicare Part B drugs

  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 0-35% coinsurance (Authorization Required)
  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 0-20% coinsurance (Authorization Required)

Mental health services

  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $20 copay
  • Inpatient hospital – psychiatric
    • In-Network: $450 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $20 copay
  • Inpatient hospital – psychiatric
    • Out-of-Network: $600 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
  • Outpatient individual therapy visit
    • Out-of-Network: $50 copay
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $20 copay
    • Out-of-Network: $50 copay
  • Outpatient group therapy visit
    • Out-of-Network: $50 copay
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: $50 copay
  • Outpatient individual therapy visit
    • In-Network: $20 copay

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $350 copay per visit (Authorization Required)
    • Out-of-Network: $500 copay per visit (Authorization Required)

Preventive care

    • Out-of-Network: $0 copay
    • In-Network: $0 copay

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • In-Network: $55 copay
  • Occupational therapy visit
    • Out-of-Network: $70 copay
    • In-Network: $45 copay
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: $70 copay

Skilled Nursing Facility

    • Out-of-Network: $0 per day for days 1 through 20
      $225 per day for days 21 through 55
      $0 per day for days 56 through 100 (Authorization Required)
    • In-Network: $0 per day for days 1 through 20
      $210 per day for days 21 through 55
      $0 per day for days 56 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Eyeglass frames
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: 50% coinsurance (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
  • Upgrades
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: 50% coinsurance (Limits Apply)
  • Contact lenses
    • Out-of-Network: 50% coinsurance (Limits Apply)
  • Eyeglass frames
    • Out-of-Network: 50% coinsurance (Limits Apply)
  • Other
    • Not covered
  • Routine eye exam
    • Out-of-Network: 50% coinsurance (Limits Apply)
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • Not covered

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

    • Covered

Ready to sign up for Vermont Blue Advantage Freedom PPO (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 Vermont Blue Advantage Freedom PPO (PPO)? See 2025 Vermont Blue Advantage Freedom PPO (PPO) at MedicareAdvantageRX.com.

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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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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 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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