Skip to Main Content
Farm Bureau Health Plans

EDUCATION & RESOURCES

2024 Farm Bureau Advantage HMO Documents & Forms Permission to Contact Provider Directory Dental Benefits Vision Benefits Fitness Benefit -Silver & Fit Formulary
How Medicare Works Enrollment/Disenrollment Appeals Filing a Grievance How to Appoint a Representative Premium Payment Terms & Conditions Medicare's Extra Help Program Medication Therapy Management (MTM) Coverage Determination Transition Policy

MEDICARE RESOURCES

Medicare.gov Medicare Complaint Form Medicare Prescription Drug Coverage Determinations Best Available Evidence for Low-Income Subsidy
Farm Bureau Health Plans will no longer offer Medicare Advantage plans in 2025

2024 Farm Bureau Advantage HMO

Farm Bureau Advantage HMO is our brand new Medicare plan offering for 2024. Enrollment for 2024 begins October 15, 2023.

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, OTC, 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
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Monthly Plan Premium
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Annual Medical Deductible
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Maximum Out of Pocket
Central Tennessee
$5,300 annually
Tri-Cities Tennessee
$3,200 annually
Knoxville Tennessee
$3,200 annually
Inpatient Hospital Coverage
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Inpatient Hospital Coverage
Central Tennessee
$300 days 1 - 5, $0 days 6 - 90
Tri-Cities Tennessee
$300 days 1 - 5, $0 days 6 - 90
Knoxville Tennessee
$300 days 1 - 5, $0 days 6 - 90
Outpatient Hospital Coverage
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Ambulatory Surgery Center
Central Tennessee
$225
Tri-Cities Tennessee
$175
Knoxville Tennessee
$175
Outpatient Surgery (Hospital)
Central Tennessee
$250
Tri-Cities Tennessee
$250
Knoxville Tennessee
$250
Doctor Visits
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Primary Care Provider
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Specialist
Central Tennessee
$30
Tri-Cities Tennessee
$25
Knoxville Tennessee
$30
Preventative Care
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Emergency Care
Central Tennessee
$100
Tri-Cities Tennessee
$100
Knoxville Tennessee
$100
Urgently Needed Services
Central Tennessee
$30
Tri-Cities Tennessee
$30
Knoxville Tennessee
$30
Worldwide Emergency Coverage**
Central Tennessee
$100
Tri-Cities Tennessee
$100
Knoxville Tennessee
$100
Telehealth Services
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Primary Care Provider
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Specialist
Central Tennessee
$30
Tri-Cities Tennessee
$25
Knoxville Tennessee
$30
Diagnostic Tests and Procedures*
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Primary Care Provider
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Specialist
Central Tennessee
$20
Tri-Cities Tennessee
$25
Knoxville Tennessee
$30
Hospital
Central Tennessee
$100
Tri-Cities Tennessee
$100
Knoxville Tennessee
$100
Laboratory Services*
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Primary Care Provider
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Specialist
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Freestanding Laboratory
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Urgent Care
Central Tennessee
$30
Tri-Cities Tennessee
$30
Knoxville Tennessee
$30
Hospital
Central Tennessee
$30
Tri-Cities Tennessee
$30
Knoxville Tennessee
$30
X-rays*
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Primary Care Provider
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Specialist
Central Tennessee
$30
Tri-Cities Tennessee
$25
Knoxville Tennessee
$30
Hospital
Central Tennessee
$50
Tri-Cities Tennessee
$50
Knoxville Tennessee
$50
Advanced Imaging Services*
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Primary Care Provider
Central Tennessee
$75
Tri-Cities Tennessee
$75
Knoxville Tennessee
$75
Specialist
Central Tennessee
$75
Tri-Cities Tennessee
$75
Knoxville Tennessee
$75
Freestanding Facility
Central Tennessee
$75
Tri-Cities Tennessee
$75
Knoxville Tennessee
$75
Hospital
Central Tennessee
$200
Tri-Cities Tennessee
$200
Knoxville Tennessee
$200
Therapeutic Radiological Services
Central Tennessee
$50
Tri-Cities Tennessee
$50
Knoxville Tennessee
$50
Hearing Services**
(Routine hearing exams and hearing aid copayments are not subject to the out-of-pocket maximum)
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Routine Hearing Exam one visit per year
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Hearing Aids
Central Tennessee
$599 - $899 per ear, per year copayment
Tri-Cities Tennessee
$599 - $899 per ear, per year copayment
Knoxville Tennessee
$599 - $899 per ear, per year copayment
Dental Services**
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Preventative two prophylaxis yearly
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Comprehensive
Central Tennessee
20% - 50% coinsurance
Tri-Cities Tennessee
20% - 50% coinsurance
Knoxville Tennessee
20% - 50% coinsurance
Benefit limit
Central Tennessee
$3,500
Tri-Cities Tennessee
$3,500
Knoxville Tennessee
$3,500
Vision Services**
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Routine Eye Exam
Central Tennessee
1 per year $0
Tri-Cities Tennessee
1 per year $0
Knoxville Tennessee
1 per year $0
Eyewear
Central Tennessee
$200 allowance
Tri-Cities Tennessee
$200 allowance
Knoxville Tennessee
$200 allowance
Mental Health Services*
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Inpatient Care
Central Tennessee
$300 days 1- 5, $0 days 6 - 90
Tri-Cities Tennessee
$300 days 1- 5, $0 days 6 - 90
Knoxville Tennessee
$300 days 1- 5, $0 days 6 - 90
Individual Sessions
Central Tennessee
$30
Tri-Cities Tennessee
$30
Knoxville Tennessee
$30
Group Sessions
Central Tennessee
$20
Tri-Cities Tennessee
$20
Knoxville Tennessee
$20
Ambulance*
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Air
Central Tennessee
20% coinsurance
Tri-Cities Tennessee
20% coinsurance
Knoxville Tennessee
20% coinsurance
Ground
Central Tennessee
$270 per one way trip
Tri-Cities Tennessee
$270 per one way trip
Knoxville Tennessee
$270 per one way trip
Other Services
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Skilled Nursing Facility*
Central Tennessee
$0 days 1 - 20, $203 days 21 - 100
Tri-Cities Tennessee
$0 days 1 - 20, $203 days 21 - 100
Knoxville Tennessee
$0 days 1 - 20, $203 days 21 - 100
Physical Therapy/Occupational Therapy/Speech Therapy**
Central Tennessee
$30
Tri-Cities Tennessee
$30
Knoxville Tennessee
$30
Medicare Part B Drugs
Central Tennessee
20% coinsurance
Tri-Cities Tennessee
20% coinsurance
Knoxville Tennessee
20% coinsurance
Over The Counter (OTC) Drug Card******
Central Tennessee
$150 allowance per quarter
Tri-Cities Tennessee
$150 allowance per quarter
Knoxville Tennessee
$150 allowance per quarter
Chiropractic Services - Medicare covered***
Central Tennessee
$20
Tri-Cities Tennessee
$20
Knoxville Tennessee
$20
Durable Medical Equipment (DME)****
Central Tennessee
20% coinsurance
Tri-Cities Tennessee
20% coinsurance
Knoxville Tennessee
20% coinsurance
Diabetic Supplies*****
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Fitness Club Membership
Central Tennessee
$10 home fitness kit, $25 annual fitness membership
Tri-Cities Tennessee
$10 home fitness kit, $25 annual fitness membership
Knoxville Tennessee
$10 home fitness kit, $25 annual fitness membership
Podiatry Services*
Central Tennessee
$30
Tri-Cities Tennessee
$30
Knoxville Tennessee
$30
Transportation
Central Tennessee
Non-covered
Tri-Cities Tennessee
Non-covered
Knoxville Tennessee
Non-covered

 

* Services may require Prior Authorization and may require a Primary Care Physician (PCP) Referral.

** Does not count toward your out of pocket maximum.

*** Medicare Covered Benefits only. Routine care and other chiropractic services not covered.

**** Most DMEs require Prior Authorization and a Referral from you PCP.

***** 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.

****** Amounts do not roll over to next 3 month period.

Prescription Drug Coverage
Central Tennessee
Tri-Cities Tennessee
Knoxville Tennessee
Central Tennessee
What you pay
Tri-Cities Tennessee
What you pay
Knoxville Tennessee
What you pay
Part D Deductible
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Tier 1: Preferred Generic
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Tier 2: Generic
Central Tennessee
$7
Tri-Cities Tennessee
$5
Knoxville Tennessee
$5
Tier 3: Preferred Brand
Central Tennessee
$47
Tri-Cities Tennessee
$47
Knoxville Tennessee
$47
Tier 4: Non-Preferred Drug
Central Tennessee
$100
Tri-Cities Tennessee
$100
Knoxville Tennessee
$100
Tier 5: Specialty Tier
Central Tennessee
33%
Tri-Cities Tennessee
33%
Knoxville Tennessee
33%
Mail Order 100 Day Supply: Tier 1 Preferred Generic
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Mail Order 100 Day Supply: Tier 2 Generic
Central Tennessee
$0
Tri-Cities Tennessee
$0
Knoxville Tennessee
$0
Mail Order 100 Day Supply: Tier 3 Preferred Brand
Central Tennessee
$141
Tri-Cities Tennessee
$141
Knoxville Tennessee
$141
Mail Order 100 Day Supply: Tier 4 Non-Preferred Drug
Central Tennessee
$300
Tri-Cities Tennessee
$300
Knoxville Tennessee
$300
Mail Order 100 Day Supply: Tier 5 Specialty Tier
Central Tennessee
Not covered
Tri-Cities Tennessee
Not covered
Knoxville Tennessee
Not covered
Select Insulins - 30 days
Central Tennessee
$35
Tri-Cities Tennessee
$35
Knoxville Tennessee
$35
Initial Coverage Limit (ICL)

Initial Coverage Limit is $5,030.00. 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 Stage

You stay in this stage until your out of pocket costs reach a total of $8,000.00. 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.


Coverage Gap Stage coinsurance requirements do not apply to Part D covered insulin products and most adult Part D vaccines, including shingles, tetanus, and travel vaccines. You won’t pay more than $35 for a one-month supply of each covered insulin product regardless of the cost-sharing tier.

Catastrophic Coverage Stage

Catastrophic Coverage Limit is $8,000.00. Catastrophic coverage begins after your total yearly drug cost reaches $8,000.00. During this time, the plan pays all of the cost for your drugs. Please reference the Evidence of Coverage, available online, for complete information regarding the Catastrophic Coverage Stage.

Insulin is covered at no more than $35 per month or 30 day supply regardless of coverage tier. Insulin drugs are covered under Tier 3 and Tier 4.

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 10/1/23)

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

Enrollment Form (PDF) (updated 10/1/23)

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

Annual Wellness Visit - Checklist (PDF) (updated 6/13/24)

CMS covers the cost of an annual wellness visit (also referred to as a “Medicare Wellness Visit”) once every twelve (12) months to develop, or update, a beneficiary’s Personalized Prevention Plan (PPP) and perform a Health Risk Assessment (HRA).

Evidence of Coverage - Central Tennessee (PDF) (updated 4/8/24)

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 4/8/24)

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 4/8/24)

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

Pharmacy Directory (PDF) (updated 10/30/24)

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

Comprehensive Formulary (PDF) (updated 12/1/24)

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

Comprehensive Formulary - Large Print (PDF) (updated 12/1/24)

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) (Updated 12/1/24)

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

Step Therapy Criteria (PDF) (Updated 12/1/24)

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

Quantity Limits Criteria (PDF) (Updated 12/1/24)

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.