Blue Medicare Freedom+ (PPO) Medicare Advantage Plan H3404-004 • 2027 • Alexander County, NC
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- −$76.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Alexander County, NC
- Local Enrollment
- 0 beneficiaries in Alexander County
Blue Medicare Freedom+ (PPO) Introduction
Blue Medicare Freedom+ is a Medicare Advantage PPO plan offered by Blue Cross and Blue Shield of North Carolina. It uses a Preferred Provider Organization (PPO) provider network and comes without prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. CMS Plan ID H3404-004 identifies this plan.
You must live in Alexander County, North Carolina to enroll in this plan. CMS reports 0 beneficiaries enrolled in this plan in Alexander County. For assistance with this plan, new members can call (866)760-0823 (TTY 711).
Compare Similar Plans in Alexander County
Compare this plan with the two most-enrolled PPO plans available in Alexander County, North Carolina. Enrollment is based on CMS local enrollment data.
| Plan Detail | Blue Medicare Freedom+ | Aetna Medicare Signature | Blue Medicare PPO Enhanced |
|---|---|---|---|
| CMS Plan ID | H3404-004-0 |
H5521-081-0 |
H3404-003-2 |
| Local Enrollment | 0 | 382 | 58 |
| Monthly Premium | $0.00 | $0.00 | $70.00 |
| Medical Deductible | $0.00 | $0.00 | $170 |
| Maximum Out-of-Pocket | $9,850.00 | $5,900.00 | $6,900.00 |
| Part B Giveback | −$76.00 reduction | Not offered | Not offered |
| Primary Care | 20% coinsurance | $0 copay | $0 copay |
| Specialist | 20% coinsurance | $0-$35 copay | $30 copay |
| Part D Deductible | Not Applicable | $500.00 | $700.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | Not covered | $0 copay | $0 copay |
| Vision | Not covered | $0 copay | $0 copay |
| Hearing | Not covered | $0 copay | Not covered |
Plan Benefits
Blue Medicare Freedom+ 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 H3404-004.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H3404-004-0 Cost Compare.
Office Visits
- Primary care
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance - Specialist
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: $0 copay - Telehealth benefit
- In-network: 0%-20% coinsurance
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance - Lab services
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance - Outpatient x-rays
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance - Diagnostic tests and procedures
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $115 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $40 copay
- Inpatient hospital care
- In-network:
Tier 1
$868 Lifetime Reserve Days for days 1-60
$2,241 per stay
Out-of-network:
40% per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-60
$221 per day for days 61-100
Out-of-network:
40% per stay - Ground ambulance
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance
Mental Health Services
- Outpatient individual therapy
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance - Outpatient group therapy
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance - Inpatient psychiatric hospital care
- In-network:
Tier 1
$868 Lifetime Reserve Days for days 1-60
$2,241 per stay
Out-of-network:
40% per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $35 copay
Out-of-network: 40% coinsurance - Occupational therapy
- In-network: $35 copay
Out-of-network: 40% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance - Durable medical equipment
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance - Prosthetics
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance
Dental Services
- Oral exam
- Not covered
- Dental x-rays
- Not covered
- Cleaning
- Not covered
- Periodontics
- Not covered
- Endodontics
- Not covered
- Restorative services
- Not covered
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- Not covered
Vision Services
- Routine eye exam
- Not covered
- Contact lenses
- Not covered
- Eyeglass frames only
- Not covered
- Eyeglass lenses only
- Not covered
- Eyeglasses (frames & lenses)
- Not covered
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- Not covered
- Fitting/evaluation
- Not covered
- Prescription hearing aids
- Not covered
- 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 Medicare Freedom+ 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: H3404)
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 North Carolina
- Website
- Blue Cross and Blue Shield of North Carolina Plan Page
- Providers
- Blue Cross and Blue Shield of North Carolina Providers Page
- Formulary
- Blue Cross and Blue Shield of North Carolina Formulary Page
- Pharmacy
- Blue Cross and Blue Shield of North Carolina Pharmacy Page
- New Member Health Plan Help
- (866)760-0823
- 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 North Carolina (official source) | https://www.bluecrossnc.com/me | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.