5

5 out of 5 stars* for plan year 2024

Plan ID: H5526-020

What You Need to Know:

  • BlueCross BlueShield Freedom Nation (PPO) is a Medicare Advantage Health Maintenance Organization Local PPO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $25, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $300 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $7,550 per year (in-network).
  • BlueCross BlueShield Freedom Nation (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $300 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $14.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$25

Monthly Premium

Medicare Plan Features
Monthly Premium: $25.00
Part C Premium: $0
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$25.00 $0 $14.00 $11.00 $25.00 $300.0 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H5526-021
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: No additional gap coverage, only the Donut Hole Discount
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $7,550
Annual Deductible: $300 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Erie, New York: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
1,427 members 5 out of 5 Stars. This plan qualifies for the 5-star rating Special Enrollment period. Read more. 5 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,740 drugs
Number of Members Enrolled in this Plan in Erie, New York: NULL
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$0.00 $14.00 $11.00 $25.00
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$11.00 $21.50 $21.50 $18.00 $18.00 $14.50 $14.50
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
398 $4.00 1755 $12.00 436 $42.00 363 $94.00 788 27%

Other Medicare Advantage Plans in Erie, New York

Plan Name Type Premium MOOP Rx Deduct. Rating
UnitedHealthcare Medicare Advantage Choice Plan 1 (Region (2023)Regional PPO$6,700$300
5
UnitedHealthcare Medicare Advantage Patriot (Regional PPO (2023)Regional PPO *$6,700$-
5
UnitedHealthcare Medicare Advantage Choice Plan 3 (Region (2023)Regional PPO$6,700$275
5
MVP Medicare WellSelect with Part D (PPO) (2023)Local PPO$7,550$300
4
MVP Medicare Patriot Plan with Part D (PPO) (2023)Local PPO$7,550$250
4
UnitedHealthcare Medicare Advantage Choice Plan 4 (Region (2023)Regional PPO$6,700$150
5
BlueCross BlueShield Forever Blue Value (PPO) (2023)Local PPO$6,700$0
5
BlueCross BlueShield Senior Blue Select (HMO) (2023)Local HMO$6,700$190
3
Fidelis Medicare Advantage Flex (HMO-POS) (2023)Local HMO$7,550$445
New plan - not yet rated.
BlueCross BlueShield BlueSaver (HMO) (2023)Local HMO$7,550$290
3
Aetna Medicare Elite Plan (PPO) (2023)Local PPO$7,550$0
5
Aetna Medicare Premier Plan (PPO) (2023)Local PPO$7,550$100
5
WellCare Patriot (HMO) (2023)Local HMO *$6,700$-
5
Fidelis Medicare $0 Premium (HMO) (2023)Local HMO$7,550$0
New plan - not yet rated.
Fidelis Medicare Advantage without Rx (HMO-POS) (2023)Local HMO *$7,550$-
New plan - not yet rated.
WellCare Value (HMO) (2023)Local HMO$6,700$0
5
Independent Health's Medicare Passport Prime (PPO) (2023)Local PPO$7,550$0
4
Univera SeniorChoice Select (HMO-POS) (2023)Local HMO *$4,500$-
4
Centers Plan for Medicare Advantage Care (HMO) (2023)Local HMO$7,550$395
3
Univera SeniorChoice Secure (HMO-POS) (2023)Local HMO$4,500$0
4
Aetna Medicare Credit Plan (PPO) (2023)Local PPO$7,550$250
5
Univera SeniorChoice Value (HMO) (2023)Local HMO$6,700$0
4
Univera SeniorChoice Value Plus (HMO-POS) (2023)Local HMO$5,000$0
4
MVP Medicare Secure with Part D (HMO-POS) (2023)Local HMO$7,550$350
4
WellCare Absolute (PPO) (2023)Local PPO$7,550$150
5
Univera SeniorChoice Basic (HMO) (2023)Local HMO$7,550$360
4
Univera SeniorChoice Advanced (HMO-POS) (2023)Local HMO$7,200$150
4
WellCare Today's Options Premier 300 (PFFS) (2023)PFFS *$-$-
5
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$7,550$-
5
MVP Medicare Preferred Gold without Part D (HMO-POS) (2023)Local HMO *$7,550$-
4
BlueCross BlueShield Forever Blue 751 (PPO) (2023)Local PPO$6,700$0
5
MVP Medicare Preferred Gold with Part D (HMO-POS) (2023)Local HMO$7,550$0
4
WellCare Summit (PPO) (2023)Local PPO$6,700$445
5
Independent Health's Encompass 65 (HMO) (2023)Local HMO *$7,550$-
3
Independent Health's Encompass 65 Basic (HMO) (2023)Local HMO$7,550$150
3
Independent Health's Encompass 65 Core (HMO) (2023)Local HMO$7,550$225
3
WellCare Today's Options Advantage Plus 150A (PPO) (2023)Local PPO$3,400$0
5
Independent Health's Encompass 65 Element (HMO) (2023)Local HMO$7,550$375
3
AARP Medicare Advantage (HMO) (2023)Local HMO$6,700$250
5
WellCare Today's Options Premier Plus 250A (PFFS) (2023)PFFS$-$0
5
BlueCross BlueShield Senior Blue 651 (HMO) (2023)Local HMO$6,700$0
3
WellCare Today's Options Advantage Plus 550B (PPO) (2023)Local PPO$6,700$0
5
Aetna Medicare Value Plan (HMO) (2023)Local HMO$7,550$250
5
BlueCross BlueShield Senior Blue 601 (HMO) (2023)Local HMO *$6,700$-
3
WellCare Today's Options Premier Plus 650B (PFFS) (2023)PFFS$-$0
5
Independent Health's Medicare Passport Advantage (PPO) (2023)Local PPO$7,550$100
4
WellCare Today's Options Premier 200 (PFFS) (2023)PFFS *$-$-
5
Medicare Advantage Plans by BlueCross BlueShield of WNY and BlueShield of NEN
BlueCross BlueShield Forever Blue Value (PPO) (2023)Local PPO$6,700$0
5
BlueCross BlueShield Senior Blue Select (HMO) (2023)Local HMO$6,700$190
3
BlueCross BlueShield BlueSaver (HMO) (2023)Local HMO$7,550$290
3
BlueCross BlueShield Forever Blue 751 (PPO) (2023)Local PPO$6,700$0
5
BlueCross BlueShield Senior Blue 651 (HMO) (2023)Local HMO$6,700$0
3
BlueCross BlueShield Senior Blue 601 (HMO) (2023)Local HMO *$6,700$-
3

Find Medicare Advantage Plans in New York