Blue Medicare Freedom+ (PPO)

Available to residents of Washington County, NC for 2027. Contract H3404, plan 004, segment 0.

2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.

New for 2027. This plan has no 2026 predecessor in the CMS crosswalk. Every NC plan’s 2026–2027 changes →

Plan details

Monthly premium (Part C + D)	$0.00
— medical (Part C) part	$0.00
— drug (Part D) part	—?
Part B premium reduction (giveback)	$76.00 a month?You must continue to pay your Medicare Part B premium.
In-network out-of-pocket maximum	$9,850.00?
In- and out-of-network out-of-pocket maximum	$14,800.00
Drug deductible	this plan has no drug coverage
Plan type	PPO?
Contract / plan	H3404-004-0
Offered by	Blue Cross and Blue Shield of North Carolina
Parent organization	CuraCor Solutions Corp.
Pharmacy search	medicare.bluecrossnc.com/prescription-drug-coverage
Member services	(866)760-0823TTY 711

CMS star ratings

Overall: 4.5 out of 5 stars for Overall
Health plan (Part C): 4.5 out of 5 stars for Health plan (Part C)
Drug plan (Part D): 4 out of 5 stars for Drug plan (Part D)

Published per contract — every plan under contract H3404 shares this rating.

Plan health benefits

Service	In-network	Out-of-network?
Doctor visits
Primary care doctor	20% coinsurance	40% coinsurance
Specialist	20% coinsurance	40% coinsurance
Other health care professional	20% coinsurance	40% coinsurance
Additional telehealth services	0%–20% coinsurance(authorization required)	—
Preventive care
Medicare-covered preventive services	$0 copay	$0 copay
Annual physical exam	$0 copay	$0 copay
Kidney disease education	$0 copay	$0 copay
Glaucoma screening	$0 copay	$0 copay
Diabetes self-management training	$0 copay	$0 copay
Diagnostic tests, labs and imaging
Diagnostic tests and procedures	20% coinsurance(authorization required)	40% coinsurance
Lab services	20% coinsurance(authorization required)	40% coinsurance
Diagnostic radiology (e.g. MRI, CT)	20% coinsurance(authorization required)	40% coinsurance
Therapeutic radiology	20% coinsurance(authorization required)	40% coinsurance
Outpatient x-rays	20% coinsurance(authorization required)	40% coinsurance
Emergency and urgent care
Emergency room	$115 copay	—
Urgent care	$40 copay	—
Worldwide emergency coverage	Not covered	—
Worldwide urgent care	Not covered	—
Worldwide emergency transportation	Not covered	—
Hospital care
Inpatient hospital stay	$2,241 per stay(authorization required)	40% coinsurance per stay
Outpatient hospital services	20% coinsurance(authorization required)	40% coinsurance
Outpatient observation	20% coinsurance	40% coinsurance
Ambulatory surgical center	20% coinsurance(authorization required)	40% coinsurance
Outpatient blood services	20% coinsurance	40% coinsurance
Skilled nursing and home health
Skilled nursing facility	$0 per day for days 1–20; $221 per day for days 21–60; $221 per day for days 61–100(authorization required)	40% coinsurance per stay
Home health care	0% coinsurance(authorization required)	40% coinsurance
Kidney dialysis	20% coinsurance	20% coinsurance
Rehabilitation
Occupational therapy	$35 copay	40% coinsurance
Physical therapy and speech-language therapy	$35 copay	40% coinsurance
Cardiac rehabilitation	$30 copay	40% coinsurance
Pulmonary rehabilitation	$25 copay	40% coinsurance
Mental health and substance use
Inpatient psychiatric hospital stay	$2,091 per stay(authorization required)	40% coinsurance per stay
Outpatient mental health, individual session	20% coinsurance	40% coinsurance
Outpatient mental health, group session	20% coinsurance	40% coinsurance
Psychiatrist, individual session	20% coinsurance	40% coinsurance
Psychiatrist, group session	20% coinsurance	40% coinsurance
Partial hospitalization	20% coinsurance(authorization required)	40% coinsurance
Intensive outpatient program	20% coinsurance(authorization required)	40% coinsurance
Outpatient substance use, individual session	20% coinsurance	40% coinsurance
Outpatient substance use, group session	20% coinsurance	40% coinsurance
Opioid treatment program	20% coinsurance	40% coinsurance
Ambulance and transportation
Ground ambulance	20% coinsurance(authorization required)	40% coinsurance
Air ambulance	20% coinsurance(authorization required)	40% coinsurance
Transportation to plan-approved locations	Not covered	—
Medical equipment and supplies
Durable medical equipment (e.g. wheelchairs, oxygen)	20% coinsurance(authorization required)	40% coinsurance
Prosthetics (e.g. braces, artificial limbs)	20% coinsurance(authorization required)	40% coinsurance
Medical supplies	20% coinsurance(authorization required)	40% coinsurance
Diabetes supplies	20% coinsurance(authorization required)	40% coinsurance
Diabetic therapeutic shoes or inserts	20% coinsurance(authorization required)	40% coinsurance
Chiropractic, acupuncture and foot care
Chiropractic (Medicare-covered)	$15 copay	40% coinsurance
Routine chiropractic care	Not covered	—
Acupuncture	Not covered	—
Foot exams and treatment (Medicare-covered)	20% coinsurance	40% coinsurance
Routine foot care	Not covered	—
Dental?
Medicare-covered dental services	20% coinsurance(authorization required)	40% coinsurance
Oral exams	Not covered	—
Cleanings	Not covered	—
Fluoride treatment	Not covered	—
Dental x-rays	Not covered	—
Other diagnostic dental services	Not covered	—
Other preventive dental services	Not covered	—
Restorative services (fillings, crowns)	Not covered	—
Endodontics (root canals)	Not covered	—
Periodontics (gum disease)	Not covered	—
Dentures and other removable prosthodontics	Not covered	—
Maxillofacial prosthetics	Not covered	—
Implants	Not covered	—
Bridges and other fixed prosthodontics	Not covered	—
Oral and maxillofacial surgery	Not covered	—
Orthodontics	Not covered	—
Adjunctive general services	Not covered	—
Vision?
Eye exam (Medicare-covered)	$0 copay; 20% coinsurance	40% coinsurance
Routine eye exam	Not covered	—
Eyewear after cataract surgery (Medicare-covered)	$0 copay	40% coinsurance
Contact lenses	Not covered	—
Eyeglasses (frames and lenses)	Not covered	—
Eyeglass lenses	Not covered	—
Eyeglass frames	Not covered	—
Eyewear upgrades	Not covered	—
Hearing?
Hearing exam (Medicare-covered)	20% coinsurance	40% coinsurance
Routine hearing exam	Not covered	—
Hearing aid fitting and evaluation	Not covered	—
Hearing aids (all types)	Not covered	—
Hearing aids, inner ear	Not covered	—
Hearing aids, outer ear	Not covered	—
Hearing aids, over the ear	Not covered	—
Medicare Part B drugs
Part B insulin	$35 copay(authorization required, step therapy may apply)	40% coinsurance
Chemotherapy and radiation drugs	0%–20% coinsurance(authorization required, step therapy may apply)	40% coinsurance
Other Part B drugs	0%–20% coinsurance(authorization required, step therapy may apply)	40% coinsurance
Other extra benefits?
Over-the-counter (OTC) allowance	Covered (allowance not stated)	—
Meals after a hospital stay or for a chronic condition	Not covered	—
Fitness benefit	Not covered	—
Health education	Not covered	—
Nutritional / dietary benefit	Not covered	—
Extra smoking and tobacco cessation counseling	$0 copay	$0 copay
Enhanced disease management	Not covered	—
Telemonitoring	Not covered	—
Remote access technologies (web/phone, nurse line)	Not covered	—
Home and bathroom safety devices	Not covered	—
Counseling services	Not covered	—
In-home safety assessment	Not covered	—
Personal emergency response system (PERS)	Not covered	—
Medical nutrition therapy	Not covered	—
Post-discharge in-home medication reconciliation	Not covered	—
Re-admission prevention	Not covered	—
Wigs for hair loss from chemotherapy	Not covered	—
Weight management programs	Not covered	—
Alternative therapies	Not covered	—
Therapeutic massage	Not covered	—
Adult day health services	Not covered	—
Home-based palliative care	Not covered	—
In-home support services	Not covered	—
Support for caregivers	Not covered	—

In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2027). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed; an out-of-network dash means the plan files no separate out-of-network cost for that service. Contact the plan for the full Evidence of Coverage.

Star rating measures

Measures are paired between the two years by name, not by the C/D number: CMS reuses those numbers, and in 2027 nineteen of them refer to a different measure than they did in 2026. A measure introduced for 2027 has no 2026 score to show. Published per contract — every plan under H3404 shares it.

Benefits in plain text

Blue Medicare Freedom+ (PPO) (H3404-004-0) is a 2027 PPO Medicare Advantage health plan without drug coverage offered by Blue Cross and Blue Shield of North Carolina, available to residents of Washington County, NC.

The monthly premium is $0.00.

The plan reduces the member's Medicare Part B premium by $76.00 a month (a "giveback"); the Part B premium itself must still be paid.

Its in-network out-of-pocket maximum is $9,850.00.

The combined in- and out-of-network out-of-pocket maximum is $14,800.00.

CMS gives the plan's contract (H3404) an overall rating of 4.5 out of 5 stars.

Email a copy of the plan benefit details

Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.