Blue Cross Medicare Advantage Freedom Blue (PPO) Medicare Advantage Plan H5959-018 • 2027 • Benton County, MN
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $6900.00In-network
- Part B Giveback
- −$145.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Benton County, MN
- Local Enrollment
- 368 beneficiaries in Benton County
Blue Cross Medicare Advantage Freedom Blue (PPO) Introduction
CMS Plan ID H5959-018 identifies Blue Cross Medicare Advantage Freedom Blue, a Medicare Advantage PPO plan offered by Blue Cross and Blue Shield of Minnesota. The plan uses a Preferred Provider Organization (PPO) provider network and comes without prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $0.00 medical deductible, and $6900.00 in-network maximum out-of-pocket.
This plan is available to eligible beneficiaries who live in Benton County, Minnesota. CMS reports local enrollment of 368 beneficiaries for this plan in Benton County. New members can contact the plan at (855)579-7658 (TTY 711) for help and additional plan information.
Compare Similar Plans in Benton County
Compare this plan with the two most-enrolled PPO plans available in Benton County, Minnesota. Enrollment is based on CMS local enrollment data.
| Plan Detail | Blue Cross Medicare Advantage Freedom Blue | Medica Advantage Select | HealthPartners Journey Pace |
|---|---|---|---|
| CMS Plan ID | H5959-018-0 |
H8889-002-0 |
H4882-017-0 |
| Local Enrollment | 368 | 400 | 0 |
| Monthly Premium | $0.00 | $122.00 | $40.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $6,900.00 | $7,150.00 | $7,150.00 |
| Part B Giveback | −$145.00 reduction | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $40 copay | $60 copay | $0-$55 copay |
| Part D Deductible | Not Applicable | $420.00 | $700.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $20 copay | $0 copay | $0 copay |
| Hearing | $0-$20 copay | $0 copay | $0 copay |
Plan Benefits
Blue Cross Medicare Advantage Freedom Blue has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H5959-018.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5959-018-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: 50% coinsurance - Specialist
- In-network: $40 copay
Out-of-network: 50% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: 50% coinsurance - Telehealth benefit
- In-network: $0-$40 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- In-network: $0 copay
Out-of-network: 50% coinsurance - Over-the-counter drug benefits
- In-network: $0 copay
Out-of-network: 80% coinsurance - Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0-$200 copay
Out-of-network: 50% coinsurance - Lab services
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Outpatient x-rays
- In-network: $10 copay
Out-of-network: 50% coinsurance - Diagnostic tests and procedures
- In-network: $0-$20 copay
Out-of-network: 50% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $50 copay
- Inpatient hospital care
- In-network:
Tier 1
$250 per day for days 1-6
$0 per day for days 7-90
$0 Lifetime Reserve Days for days 1-60
$0 per stay
Out-of-network:
50% per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100
Out-of-network:
50% per stay - Ground ambulance
- In-network: $300 copay
Out-of-network: $300 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $40 copay
Out-of-network: 50% coinsurance - Outpatient group therapy
- In-network: $40 copay
Out-of-network: 50% coinsurance - Inpatient psychiatric hospital care
- In-network:
Tier 1
$250 per day for days 1-6
$0 per day for days 7-90
$0 Lifetime Reserve Days for days 1-60
$0 per stay
Out-of-network:
50% per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $40 copay
Out-of-network: 50% coinsurance - Occupational therapy
- In-network: $40 copay
Out-of-network: 50% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
Out-of-network: 50% coinsurance - Durable medical equipment
- In-network: 20% coinsurance
Out-of-network: 50% coinsurance - Prosthetics
- In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Dental x-rays
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Cleaning
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Periodontics
- In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance - Endodontics
- In-network: 20% coinsurance
Out-of-network: 20% coinsurance - Restorative services
- In-network: 20% coinsurance
Out-of-network: 20% coinsurance - Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Vision Services
- Routine eye exam
- In-network: $20 copay
Out-of-network: 50% coinsurance - Contact lenses
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Eyeglass frames only
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Eyeglass lenses only
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Eyeglasses (frames & lenses)
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0-$20 copay
Out-of-network: 80% coinsurance - Fitting/evaluation
- In-network: $0 copay
Out-of-network: 80% coinsurance - Prescription hearing aids
- In-network: $599-$899 copay
Out-of-network: 80% coinsurance - OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by Blue Cross Medicare Advantage Freedom Blue as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Performance Ratings (Contract ID: H5959)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Blue Cross and Blue Shield of Minnesota
- Website
- Blue Cross and Blue Shield of Minnesota Plan Page
- Providers
- Blue Cross and Blue Shield of Minnesota Providers Page
- Formulary
- Blue Cross and Blue Shield of Minnesota Formulary Page
- Pharmacy
- Blue Cross and Blue Shield of Minnesota Pharmacy Page
- New Member Health Plan Help
- (855)579-7658
- New Member Health Plan TTY
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Blue Cross and Blue Shield of Minnesota (official source) | http://www.bluecrossmn.com/medicare | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | 25 May, 2025 |
| Medicare.gov | Explore your Medicare coverage options | 25 May, 2025 |
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