BlueAdvantage Freedom (PPO) Medicare Advantage Plan H7917-039 • 2027
CMS Rating:
(3.5 out of 5 stars*)
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4450.00In-network
- Part B Giveback
- −$70.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 1,704 beneficiaries
Last update:
BlueAdvantage Freedom (PPO) Introduction
CMS Plan ID H7917-039 identifies BlueAdvantage Freedom, a Medicare Advantage PPO plan offered by BlueCross BlueShield of Tennessee. 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 $4450.00 in-network maximum out-of-pocket.
Plan Benefits
BlueAdvantage 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 H7917-039.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: $10 copay |
| Specialist | In-network: $30 copay Out-of-network: 50% coinsurance |
In-network: $25 copay Out-of-network: $30 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay |
| Telehealth benefit | In-network: $0 copay | In-network: $0 copay |
| 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: 80% 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: $110 copay Out-of-network: 50% coinsurance |
In-network: $110 copay Out-of-network: 50% coinsurance |
| Lab services | In-network: $0-$30 copay, 20% coinsurance Out-of-network: 50% coinsurance |
In-network: $0-$30 copay, 20% coinsurance Out-of-network: 50% coinsurance |
| Outpatient x-rays | In-network: $0-$35 copay Out-of-network: 50% coinsurance |
In-network: $0-$35 copay Out-of-network: 50% coinsurance |
| Diagnostic tests and procedures | In-network: $0-$35 copay Out-of-network: 50% coinsurance |
In-network: $0-$35 copay Out-of-network: 50% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $150 copay | $150 copay |
| Worldwide emergency care | Coming soon | $60 copay |
| Urgent care | $45 copay | $45 copay |
| Inpatient hospital care | In-network: Tier 1 $225 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 50% per stay |
In-network: Tier 1 $175 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: $225 per day for days 1-5 $0 per day for days 6-90 $0 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 |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 Out-of-network: 50% per stay |
| Ground ambulance | In-network: $250 copay Out-of-network: $250 copay |
In-network: $250 copay Out-of-network: $250 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $25 copay Out-of-network: 50% coinsurance |
In-network: $25 copay Out-of-network: 50% coinsurance |
| Outpatient group therapy | In-network: $15 copay Out-of-network: 50% coinsurance |
In-network: $15 copay Out-of-network: 50% coinsurance |
| Inpatient psychiatric hospital care | In-network: Tier 1 $225 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 50% per stay |
In-network: Tier 1 $175 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: $225 per day for days 1-5 $0 per day for days 6-90 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $25 copay Out-of-network: 50% coinsurance |
In-network: $25 copay Out-of-network: 50% coinsurance |
| Occupational therapy | In-network: $25 copay Out-of-network: 50% coinsurance |
In-network: $25 copay Out-of-network: 50% coinsurance |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 50% coinsurance |
In-network: 20% coinsurance Out-of-network: 50% coinsurance |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 50% coinsurance |
In-network: 20% coinsurance Out-of-network: 50% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
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 |
In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Dental x-rays | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Periodontics | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Endodontics | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Restorative services | In-network: 20% coinsurance Out-of-network: 50% coinsurance |
In-network: 20% coinsurance Out-of-network: 50% coinsurance |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: 20% coinsurance Out-of-network: 50% coinsurance |
In-network: 20% coinsurance Out-of-network: 50% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Contact lenses | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass frames only | Not covered | Not covered |
| Eyeglass lenses only | Not covered | Not covered |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: 90% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Fitting/evaluation | In-network: $0 copay Out-of-network: 90% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Prescription hearing aids | In-network: $199-$699 copay Out-of-network: 90% coinsurance |
In-network: $199-$699 copay Out-of-network: $199-$699 copay |
| 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 | Not covered |
| 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 BlueAdvantage 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: H7917)
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 BlueCross BlueShield of Tennessee
- Website
- BlueCross BlueShield of Tennessee Plan Page
- Providers
- BlueCross BlueShield of Tennessee Providers Page
- Formulary
- BlueCross BlueShield of Tennessee Formulary Page
- Pharmacy
- BlueCross BlueShield of Tennessee Pharmacy Page
- New Member Health Plan Help
- (800)292-5146
- 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
BlueAdvantage Freedom (H7917-039-0) is available in the following locations:
Tennessee Counties Served
- Anderson
- Bedford
- Benton
- Bledsoe
- Blount
- Bradley
- Campbell
- Cannon
- Carroll
- Carter
- Cheatham
- Chester
- Claiborne
- Clay
- Cocke
- Coffee
- Crockett
- Cumberland
- Davidson
- Decatur
- Dekalb
- Dickson
- Dyer
- Fayette
- Fentress
- Franklin
- Gibson
- Giles
- Grainger
- Greene
- Grundy
- Hamblen
- Hamilton
- Hancock
- Hardeman
- Hardin
- Hawkins
- Haywood
- Henderson
- Henry
- Hickman
- Houston
- Humphreys
- Jackson
- Jefferson
- Johnson
- Knox
- Lake
- Lauderdale
- Lawrence
- Lewis
- Lincoln
- Loudon
- Macon
- Madison
- Marion
- Marshall
- Maury
- Mcminn
- Mcnairy
- Meigs
- Monroe
- Montgomery
- Moore
- Morgan
- Obion
- Overton
- Perry
- Pickett
- Polk
- Putnam
- Rhea
- Roane
- Robertson
- Rutherford
- Scott
- Sequatchie
- Sevier
- Shelby
- Smith
- Stewart
- Sullivan
- Sumner
- Tipton
- Trousdale
- Unicoi
- Union
- Van Buren
- Warren
- Washington
- Wayne
- Weakley
- White
- Williamson
- Wilson
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About BlueAdvantage Freedom (PPO)
How much does plan H7917-039 cost per month?
For 2027, the monthly premium is $0.00. Medicare Part B premiums apply in addition to this amount.
What is the annual out-of-pocket maximum (MOOP) for this plan?
The annual in-network MOOP is $4450.00 for 2027. After this limit is reached, covered in-network services are fully paid.
How many beneficiaries are enrolled in this plan?
CMS reports 1,704 beneficiaries enrolled in this plan.
What is the Part D deductible for plan H7917-039?
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 | 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 |
|---|---|---|
| BlueCross BlueShield of Tennessee (official source) | http://bcbstmedicare.com | October 4, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| Medicare.gov | Joining a plan | 25 May, 2025 |
| Medicare.gov | Explore your Medicare coverage options | 25 May, 2025 |
MedicarePlans.com is an independent informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance documentation is maintained in alignment 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.