Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H7917-039-000

BlueAdvantage Freedom (PPO) · BlueCross BlueShield of Tennessee · Statewide Tennessee + Northwest GA

Compact plan code: H7917039000

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

BlueAdvantage Freedom (PPO)

H7917-039-000 Statewide Tennessee + Northwest GA Local PPO
Open in quick lookup
01

In-network

Inpatient hospital

Days 1–5 $175 / day
Days 6–90 $0 / day
Total of listed copays · 5 charged days $875
02

Emergency transport

Ambulance

Ground · in-network$250 copay
Air · in-network20% coinsurance
03

Emergency services

Emergency room

$150 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$3,200
Combined in + out$5,750
05

Skilled care at home

Home health

In-networkNo cost share reported
Out-of-network50% coinsurance
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + DNot reported

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release. Quick-reference values should be confirmed in current official plan documents.

PBP benefits ↗ Landscape data ↗

Same CMS contract

H7917-009-000 BlueAdvantage Diamond (PPO) Middle and West Tennessee · Local PPO H7917-010-000 BlueAdvantage Diamond (PPO) Southeast Tennessee · Local PPO H7917-011-000 BlueAdvantage Diamond (PPO) Northeast Tennessee · Local PPO H7917-012-000 BlueAdvantage Ruby (PPO) West Tennessee · Local PPO H7917-013-000 BlueAdvantage Ruby (PPO) Middle Tennessee · Local PPO H7917-014-000 BlueAdvantage Ruby (PPO) Southeast Tennessee · Local PPO H7917-015-000 BlueAdvantage Ruby (PPO) Northeast Tennessee · Local PPO H7917-030-000 BlueAdvantage Sapphire (PPO) Southeast Tennessee · Local PPO

About this code

What H7917-039-000 identifies

H7917-039-000 is a Contract Year 2026 Medicare plan segment code. The compact form H7917039000 refers to the same normalized contract, plan, and segment shown on this page.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.