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Freedom Nation (PPO)

New lost cost PPO provides a comprehensive network of providers and hospitals.  Pay in-network for all plan covered services when you receive care outside of WNY with the Blue Card Network Sharing Program. 

Freedom Nation (PPO)

PRIMARY/SPECIALTY
$15/$35

DRUG DEDUCTIBLES
Tier 1-2: $0,
Tier 3 - Tier 5: $300

INPATIENT HOSPITAL
$370 per day for days 1-5,
$1,850 OOP Max per year

MONTHLY PREMIUM

$25

MONTHLY PREMIUM

$25

Freedom Nation (PPO) Plan Details

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Primary Care Doctor/Specialist

Primary Care Doctor Specialist
$15 $35
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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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Part D Prescription Drugs

 
 
Drug Deductibles $0 Tiers 1-2; $300 Tiers 3-5
Part D Prescriptions: Preferred Pharmacy Standard Pharmacy
Tier 1 $4 $9
Tier 2 $12 $17
Tier 3 $42 $47
Tier 4 $94 $100
Tier 5 27% 27%
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$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 the 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, just in case. 

Prescription Drug Infomation
The 2021 Medicare Formulary includes a list of prescription care drugs covered by a prescription drug plan.

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Surgery & Treatment

 
 
Inpatient hospital $370/day, days 1-5 / $1,850 OOP max per year
Outpatient hospital $400
Ambulatory surgery $300
X-rays $50
Advanced radiology $200
Lab $10
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Preventive Dental

All of our plans include preventive dental coverage:

  • Routine cleanings/oral exams - twice per year ($10 copay per service).
  • X-rays - four bitewing or one full-month X-ray per year ($10 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 $11 50% coinsurance $500
Enhanced $25 50% coinsurance $1,000
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Plan Highlights

 
 
World coverage for emergency and urgent care $90/$65
Part B diabetes supplies and monitors $0
Skilled nursing facility days 1-20 $0
Skilled nursing facility days 21-100 $184/day
Hearing aid (specific models)* $699 or $999/unit
In-network out-of-pocket maximum $7,550

Explore Plan Details

Medicare Questions?

We're here to help.

1-833-735-4511 (TTY 711)

Oct. 1 - Dec. 31, 8 a.m. - 8 p.m., 7 days a week
Jan. 1 - Sept. 30, 8 a.m. to 8 p.m., Monday - Friday

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

BlueCross BlueShield of Western New York (BCBSWNY) is a division of HealthNow New York Inc., an independent licensee of the Blue Cross and Blue Shield Association. BCBSWNY 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 linguistica, 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 15, 2020