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Farm Bureau Health Plans

Education & Resources

Farm Bureau Advantage HMO Summary of Benefits Provider Directory Provider Directory - Central Tennessee (PDF) Provider Directory - Knoxville Tennessee (PDF) Provider Directory - Tri-Cities Tennessee (PDF) Dental Provider Directory Dental Provider Directory (PDF) VSP Provider Directory - Central Tennessee VSP Provider Directory - Knoxville Tennessee VSP Provider Directory - Tri-Cities Tennessee TrueHearing Provider Directory (PDF) Formulary - Central Tennessee Formulary - Knoxville Tennessee Formulary - Tri-Cities Tennessee
How Medicare Works Enrollment/Disenrollment Appeals Filing a Grievance How to Appoint a Representative Premium Payment Terms & Conditions Fraud, Waste and Abuse Medicare's Extra Help Program Medication Therapy Management (MTM) Coverage Determination Transition Policy Silver&Fit Documents & Forms Permission to Contact Dental Vision & Hearing

Medicare.gov Resources

Medicare.gov Medicare Complaint Form Medicare Prescription Drug Coverage Determinations Best Available Evidence for Low-Income Subsidy

Farm Bureau Advantage HMO

Farm Bureau Advantage HMO is our brand new Medicare plan offering for 2023. Enrollment for 2023 begins October 15, 2022.

With Farm Bureau Advantage HMO, your medical, hospital and prescription drug coverage are combined into one affordable plan. You’ll have access to cost-saving extras not covered by Original Medicare like dental, vision, hearing, a fitness program and expanded telehealth benefits.

And as a member of the Farm Bureau Health Plans family, you’ll enjoy reliable support from our helpful customer service team right here in Columbia, TN.

Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
What you pay
What you pay
What you pay
Monthly Plan Premium
$0
$0
$0
Annual Medical Deductible
$0
$0
$0
Maximum Out of Pocket
$5,300 annually
$3,200 annually
$3,200 annually
Inpatient Hospital Coverage
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
What you pay
What you pay
What you pay
Inpatient Hospital Coverage
$300 days 1 - 5, $0 days 6 - 90
$300 days 1 - 5, $0 days 6 - 90
$300 days 1 - 5, $0 days 6 - 90
Outpatient Hospital Coverage
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
What you pay
What you pay
What you pay
Ambulatory Surgery Center
$225
$175
$175
Outpatient Surgery (Hospital)
$250
$250
$250
Doctor Visits
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
What you pay
What you pay
What you pay
Primary Care Provider
$0
$0
$0
Specialist
$30
$25
$30
Preventative Care
$0
$0
$0
Emergency Care
$90
$90
$90
Urgently Needed Services
$40
$40
$40
Worldwide Emergency Coverage
$90
$90
$90
Telehealth Services
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
What you pay
What you pay
What you pay
Primary Care Provider
$0
$0
$0
Specialist
$30
$25
$30
Diagnostic Tests and Procedures*
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
What you pay
What you pay
What you pay
Primary Care Provider
$0
$0
$0
Specialist
$30
$25
$30
Hospital
$100
$100
$100
Laboratory Services*
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
What you pay
What you pay
What you pay
Primary Care Provider
$0
$0
$0
Specialist
$0
$0
$0
Freestanding Laboratory
$0
$0
$0
Urgent Care
$30
$30
$30
Hospital
$30
$30
$30
X-rays*
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
What you pay
What you pay
What you pay
Primary Care Provider
$0
$0
$0
Specialist
$30
$25
$30
Hospital
$50
$50
$50
Advanced Imaging Services*
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
What you pay
What you pay
What you pay
Primary Care Provider
$75
$75
$75
Specialist
$75
$75
$75
Freestanding Facility
$75
$75
$75
Hospital
$200
$200
$200
Therapeutic Radiological Services
$50
$50
$50
Hearing Services
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
What you pay
What you pay
What you pay
Routine Hearing Exam one visit per year
$0
$0
$0
Hearing Aids
$599 - $899 cost sharing
$599 - $899 cost sharing
$599 - $899 cost sharing
Dental Services
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
What you pay
What you pay
What you pay
Preventative three prophylaxis yearly
$0
$0
$0
Comprehensive
20% - 50%
20% - 50%
20% - 50%
Benefit limit
$3,500
$3,500
$3,500
Vision Services
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
What you pay
What you pay
What you pay
Routine Eye Exam
1 per year $0
1 per year $0
1 per year $0
Eyewear
$200 allowance
$200 allowance
$200 allowance
Mental Health Services
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
What you pay
What you pay
What you pay
Inpatient Care
$300 days 1- 5, $0 days 6 - 90
$300 days 1- 5, $0 days 6 - 90
$300 days 1- 5, $0 days 6 - 90
Individual Sessions
$30
$30
$30
Group Sessions
$20
$20
$20
Therapeutic Radiological Services
$50
$50
$50
Other Services
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
What you pay
What you pay
What you pay
Skilled Nursing Facility
$0 days 1 - 20, $188 days 21 -100
$0 days 1 - 20, $188 days 21 -100
$0 days 1 - 20, $188 days 21 -100
Physical Therapy/Occupational Therapy/Speech Therapy
$30
$30
$30
Ambulance
$270 per one way trip
$270 per one way trip
$270 per one way trip
Medicare Part B Drugs
20%
20%
20%
Chiropractic Services - Medicare covered
$20
$20
$20
Durable Medical Equipment
20%
20%
20%
Diabetic Supplies**
$0
$0
$0
Fitness Club Membership***
$10 - $25
$10 - $25
$10 - $25
Podiatry Services
$30
$30
$30
Transportation
Non-covered
Non-covered
Non-covered

 

* Services may require prior authorization from the plan.

** Diabetic supplies are limited to specific manufacturers. Test strips and monitors: One Touch, Accu-Check. Continuous glucose monitors available from Freestyle Libre or Dexcom after completing a prior authorization.

*** Home exercise program for $10 or $25 yearly membership at a Silver & Fit Fitness Center.

Prescription Drug Coverage
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
What you pay
What you pay
What you pay
Part D Deductible
$0
$0
$0
Tier 1: Preferred Generic
$0
$0
$0
Tier 2: Generic
$7
$5
$5
Tier 3: Preferred Brand
$47
$47
$47
Tier 4: Non-Preferred Drug
$100
$100
$100
Tier 5: Specialty Tier
33%
33%
33%
Mail Order 90 Day Supply: Tier 1 Preferred Generic
$0
$0
$0
Mail Order 90 Day Supply: Tier 2 Generic
$0
$0
$0
Mail Order 90 Day Supply: Tier 3 Preferred Brand
$141
$141
$141
Mail Order 90 Day Supply: Tier 4 Non-Preferred Drug
$300
$300
$300
Mail Order 90 Day Supply: Tier 5 Specialty Tier
33%
33%
33%
Select Insulins - 30 days
$35
$35
$35
Initial Coverage Limit (ICL)

Initial Coverage Limit is $4,660.00. During the Initial Coverage state, the plan pays its share of the cost of your covered prescriptions and you pay your share (your copayment or coinsurance amount). Your share of the cost will vary depending on the drug and where you fill your prescription. Please review the Evidence of Coverage online for more information on the phases of the benefit.

Coverage Gap

You stay in this stage until your out of pocket costs reach a total of $7,400.00. When you are in the Coverage Gap Stage, the Medicare Coverage Gap Discount Program provides manufacturer discounts on brand name drugs. You pay 25% of the negotiated price and a portion of the dispensing fees for brand name drugs. Please review the Evidence of Coverage online for more information on the Coverage Gap Stage.

Catastrophic Coverage Stage

Catastrophic Coverage Limit is $7,400.00. Catastrophic coverage begins after your total yearly drug cost reaches $7,400.00. During this time, the plan pays most of the cost for your drugs. Please reference the Evidence of Coverage, available online, for complete information regarding the Catastrophic Coverage Stage.

The following plan documents will help you find more information about Farm Bureau Advantage HMO. All documents are PDF (Portable Document Format) and can be viewed with Adobe Reader. If you don’t already have this viewer on your computer, download Adobe Reader for free from the Adobe website.

Summary of Benefits(PDF) (updated 11/3/22)

The Summary of Benefits provides an overview of the plan benefits.

Enrollment Form (PDF) (updated 9/27/22)

If you would like to enroll for one of our plans, you can complete the Enrollment Form and mail it to us.

Evidence of Coverage - Central Tennessee (PDF) (updated 10/13/22)

The Evidence of Coverage explains your plan benefits, your rights and responsibilities, and provides you with important contact information.

Evidence of Coverage - Knoxville Tennessee (PDF) (updated 10/13/22)

The Evidence of Coverage explains your plan benefits, your rights and responsibilities, and provides you with important contact information.

Evidence of Coverage - Tri-Cities Tennessee (PDF) (updated 10/13/22)

The Evidence of Coverage explains your plan benefits, your rights and responsibilities, and provides you with important contact information.

Pharmacy Directory (PDF) (updated 11/15/22)

The Pharmacy Directory provides you with a list of network pharmacies and their locations.

Comprehensive Formulary - Central Tennessee (PDF) (updated 9/27/22)

The Comprehensive Formulary is the list of drugs covered by this plan. The formulary also tells you if a drug is restricted.

Comprehensive Formulary - Knoxville Tennessee (PDF) (updated 9/27/22)

The Comprehensive Formulary is the list of drugs covered by this plan. The formulary also tells you if a drug is restricted.

Comprehensive Formulary - Tri-Cities Tennessee (PDF) (updated 9/27/22)

The Comprehensive Formulary is the list of drugs covered by this plan. The formulary also tells you if a drug is restricted.

Prior Authorization Criteria (PDF)

The Prior Authorization Criteria explains what is needed to review certain drugs that require prior authorization.

Step Therapy Criteria (PDF) (Updated 11/1/22)

The Step Therapy Criteria explains what is needed to review certain drugs that require step therapy.

Quantity Limits Criteria (PDF)

The Quantity Limits Criteria explains what is needed to review certain drugs with quantity limits.

CMS Star Ratings (PDF)

The Medicare program uses a 5 star system to rate all prescription drug plans based on quality and performance.