Blue Medicare Freedom+ (PPO) Medicare Advantage Plan H3404-004 • 2027
CMS Rating:
(4.5 out of 5 stars*)
- 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
- See List
- Total Enrollment
- 1,016 beneficiaries
Last update:
Blue Medicare Freedom+ (PPO) Introduction
This Medicare Advantage PPO plan, Blue Medicare Freedom+, is offered by Blue Cross and Blue Shield of North Carolina and uses a Preferred Provider Organization (PPO) provider network. It comes without prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $9850.00. The plan is identified by CMS Plan ID H3404-004.
Plan Benefits
Blue Medicare Freedom+ includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The tables below outline the most common in-network out-of-pocket costs associated with plan H3404-004.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
| Specialist | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay |
| Telehealth benefit | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
| Lab services | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
| Outpatient x-rays | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
| Diagnostic tests and procedures | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $115 copay | $115 copay |
| Worldwide emergency care | Coming soon | Not covered |
| Urgent care | $40 copay | $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 |
In-network: Tier 1 $838 Lifetime Reserve Days for days 1-60 $2,230 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 |
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 |
| Ground ambulance | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
| Outpatient group therapy | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
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 |
In-network: Tier 1 $838 Lifetime Reserve Days for days 1-60 $2,230 per stay Out-of-network: 40% per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $35 copay Out-of-network: 40% coinsurance |
In-network: $30 copay Out-of-network: 40% coinsurance |
| Occupational therapy | In-network: $35 copay Out-of-network: 40% coinsurance |
In-network: $30 copay Out-of-network: 40% coinsurance |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 40% coinsurance |
In-network: 20% coinsurance Out-of-network: 40% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 40% coinsurance |
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 |
In-network: 0%-20% coinsurance Out-of-network: 40% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | Not covered | Not covered |
| Dental x-rays | Not covered | Not covered |
| Cleaning | Not covered | Not covered |
| Periodontics | Not covered | Not covered |
| Endodontics | Not covered | Not covered |
| Restorative services | Not covered | Not covered |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | Not covered | Not covered |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | Not covered | Not covered |
| Contact lenses | Not covered | Not covered |
| Eyeglass frames only | Not covered | Not covered |
| Eyeglass lenses only | Not covered | Not covered |
| Eyeglasses (frames & lenses) | Not covered | Not covered |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | Not covered | Not covered |
| Fitting/evaluation | Not covered | Not covered |
| Prescription hearing aids | Not covered | Not covered |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | Not covered | 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)
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, 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.
Plan Availability
Blue Medicare Freedom+ (H3404-004-0) is available in the following locations:
North Carolina Counties Served
- Alamance
- Alexander
- Alleghany
- Anson
- Ashe
- Avery
- Beaufort
- Bertie
- Bladen
- Brunswick
- Buncombe
- Burke
- Cabarrus
- Caldwell
- Camden
- Carteret
- Caswell
- Catawba
- Chatham
- Cherokee
- Chowan
- Clay
- Cleveland
- Columbus
- Craven
- Cumberland
- Currituck
- Dare
- Davidson
- Davie
- Duplin
- Durham
- Edgecombe
- Forsyth
- Franklin
- Gaston
- Gates
- Graham
- Granville
- Greene
- Guilford
- Halifax
- Harnett
- Haywood
- Henderson
- Hertford
- Hoke
- Hyde
- Iredell
- Jackson
- Johnston
- Jones
- Lee
- Lenoir
- Lincoln
- Macon
- Madison
- Martin
- Mcdowell
- Mecklenburg
- Mitchell
- Montgomery
- Moore
- Nash
- New Hanover
- Northampton
- Onslow
- Orange
- Pamlico
- Pasquotank
- Pender
- Perquimans
- Person
- Pitt
- Polk
- Randolph
- Richmond
- Robeson
- Rockingham
- Rowan
- Rutherford
- Sampson
- Scotland
- Stanly
- Stokes
- Surry
- Swain
- Transylvania
- Tyrrell
- Union
- Vance
- Wake
- Warren
- Washington
- Watauga
- Wayne
- Wilkes
- Wilson
- Yadkin
- Yancey
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Blue Medicare Freedom+ (PPO)
Is there a monthly premium for this plan in 2027?
For 2027, the monthly premium is $0.00. Medicare Part B premiums apply in addition to this amount.
What is the in-network MOOP for plan H3404-004?
For 2027, the in-network maximum out-of-pocket is $9850.00. The plan pays 100% of covered in-network services beyond this amount.
What is the total enrollment for plan H3404-004?
Total enrollment is 1,016 beneficiaries based on the latest CMS data.
Is there a Part D deductible for this plan?
The Part D deductible is $0.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | November 10, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Blue Cross and Blue Shield of North Carolina (official source) | https://www.bluecrossnc.com/medicare | October 4, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| Medicare.gov | Joining a plan | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
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Provenance documentation for this data is maintained under 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.