Blue Medicare Freedom+ (PPO)

by Blue Cross and Blue Shield of North Carolina

2026 Medicare Advantage plan available in North Carolina

Plan ID H3404-004-0

Additional coverage:

(none)

Medicare Advantage PPO $0 premium 4.5 Overall

Monthly plan premium $0 / mo

Annual deductible $0 / yr

Max out-of-pocket · in-network $9,250 / yr

4.5 Overall Government Star Rating 2026 · out of 5 stars

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Plan Overview

Blue Medicare Freedom+ (PPO) is a Medicare Advantage Plan Without Prescription Drugs, which is available in North Carolina and offered by the health insurance company Blue Cross and Blue Shield of North Carolina. This plan's network type is PPO, which determines the in-network doctors who accept the plan and whether a referral is needed.

Plan Name Blue Medicare Freedom+ (PPO)

Insurance Carrier Blue Cross and Blue Shield of North Carolina

Plan Type Medicare Advantage Plan Without Prescription Drugs

Network Type PPO

Cost Summary

Blue Medicare Freedom+ (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out-of-pocket cost sharing of $9,250. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.

Monthly Premium $0 / mo

Annual Deductible $0 / yr

Max Out-of-Pocket · in-network $9,250 / yr

Primary doctor visit 20% coinsurance

Specialist visit 20% coinsurance

ER visit $115 copay

Ambulance 20% coinsurance

Additional Benefits and Coverage

Blue Medicare Freedom+ (PPO) is a Medicare Advantage plan which does not include Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Blue Medicare Freedom+ (PPO) includes coverage for .

Part D Prescription Drug Coverage No

Dental No

Vision No

Hearing No

Nationwide Coverage No

Other benefits

Fitness benefit Limited coverage

Over-the-counter drug benefits Limited coverage

In-home support services Limited coverage

Home & bathroom safety devices Not covered

Meals for short duration Limited coverage

Annual physical exams Limited coverage

Telehealth Limited coverage

Medical Benefits

Doctor Services

Primary doctor visit In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Specialist visit In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Tests, labs & imaging

Diagnostic tests & procedures In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Lab services In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Diagnostic radiology services (like MRI) In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Outpatient x-rays In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Emergency care $115 copay

Urgent care $40 copay

Hospital Services

Inpatient hospital coverage In-network:
  Tier 1
  $838 Lifetime Reserve Days for days 1-60
  $2230 per stay
Out-of-network:
  40% per stay

Outpatient hospital coverage In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Skilled nursing facility

Skilled nursing facility In-network:
  Tier 1
  $0 per day for days 1-20
  $218 per day for days 21-60
  $0 per day for days 61-100
Out-of-network:
  40% per stay

Preventive services

Preventive services In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Therapy services

Occupational therapy visit In-network: $30 copay
Out-of-network: 40% coinsurance

Physical therapy & speech & language therapy visit In-network: $30 copay
Out-of-network: 40% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Outpatient individual therapy with a psychiatrist In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Outpatient group therapy visit In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Outpatient individual therapy visit In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Opioid treatment services

Opioid treatment services Covered

Other services

Durable medical equipment (like wheelchairs & oxygen) In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Prosthetics (like braces, artificial limbs) In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Diabetes supplies In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Medicare star rating

Each year the federal government rates Medicare Advantage and Part D plans on a 5-star system covering quality of care, chronic-condition management, member experience, and customer service. For 2026, Blue Medicare Freedom+ (PPO) earned an overall rating of 4.5 stars — better than North Carolina's state average of 4.0 stars.

Rating category This plan State average

Overall star rating ★ 4.5 4.0

Health plan quality

Summary rating of health plan quality ★ 4.5 4.0

Staying healthy: screenings, tests & vaccines ★ 5.0 3.6

Managing chronic (long-term) conditions ★ 3.0 3.6

Member experience with health plan ★ 5.0 4.1

Member complaints & changes in performance ★ 4.0 3.9

Health plan customer service ★ 4.0 4.3

Extra Benefits

Hearing

Hearing exam Not covered

Fitting/evaluation Not covered

Hearing aids - prescription Not covered

Hearing aids - over the counter Not covered

Preventive dental

Oral exam Not covered

Cleaning Not covered

Fluoride treatment Not covered

Dental x-rays Not covered

Comprehensive dental

Restorative services Not covered

Endodontics Not covered

Periodontics Not covered

Prosthodontics, removable Not covered

Prosthodontics, fixed Not covered

Maxillofacial prosthetics Not covered

Implant services Not covered

Oral and maxillofacial surgery Not covered

Orthodontics Not covered

Adjunctive general services Not covered

Vision

Routine eye exam Not covered

Contact lenses Not covered

Eyeglasses (frames & lenses) Not covered

Eyeglass frames (only) Not covered

Eyeglass lenses (only) Not covered

Upgrades Not covered

Plan documents & tools

Plan details (carrier site)Provider directory Drug list (formulary)

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