A non-government entity
eternalHealth Freedom (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for eternalHealth Freedom (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on eternalHealth Freedom (PPO) in 2025, please refer to our full plan details page.
eternalHealth Freedom (PPO) is a PPO plan offered by Eternal Health of Delaware, Inc. available for enrollment in 2025 to people living in Bris, Middle, Nor, Ply, Suff & Wor. The overall rating for this plan is not yet available for 2025.
It's important to know that eternalHealth Freedom (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about eternalHealth Freedom (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For eternalHealth Freedom (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $185.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $9000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The eternalHealth Freedom (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $185.00. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $5 copay for preferred generic drugs at a standard or mail-order pharmacy. You will pay 27% coinsurance for preferred brand drugs.
Additional Benefits
The eternalHealth Freedom (PPO) plan offers comprehensive coverage for a variety of healthcare needs. You'll find coverage for inpatient and outpatient hospital services, with varying copays depending on the service. Emergency, primary care, preventive, vision, and dental services are also included, with copays for some services like eye exams, and primary care visits, and no copays for others. Additional benefits include coverage for hearing aids, transportation, and home health services, along with services such as acupuncture and over-the-counter items. The plan also covers specialized services like partial hospitalization, skilled nursing facilities, and dialysis, with specific copays or coinsurance amounts. However, it's important to note that some services, like podiatry, are not covered, and some benefits, like home health services, require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $370 for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered by the eternalHealth Freedom (PPO) plan. Outpatient hospital services have a copay between $0 and $350, observation services have a $350 copay, individual and group sessions for outpatient substance abuse have a $25 copay, and ambulatory surgical center services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the eternalHealth Freedom (PPO) plan, with a $25 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a $300 copay, and there is no coinsurance. Transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year, with no copay or coinsurance; transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the eternalHealth Freedom (PPO) plan. Emergency Services have a $100 copay, Urgently Needed Services have a copay between $0 and $25, and Worldwide Emergency Coverage has a $100 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services have a $20 copay, and Routine Chiropractic Care has a $25 copay for 20 visits per year. Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services have a $20 copay. Individual and Group Sessions for Mental Health and Psychiatric Services have copays between $0 and $25. Opioid Treatment Program Services have a $25 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive services, including annual physical exams and other services, are covered. Therapeutic massage has a $20 copay, and the plan covers up to 20 sessions per year.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $25 copay, and coverage for Fitting/Evaluation for Hearing Aid with no copay. Prescription hearing aids are covered, with a copay between $595 and $895, however, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC Hearing Aids are not covered.
Vision Services See details
The eternalHealth Freedom (PPO) plan covers vision services, including eye exams with a $25 copay. The plan also covers eyewear with a combined maximum of $200 every year for both in-network and out-of-network services, and contact lenses are covered. Upgrades are not covered.
Dental Services See details
The eternalHealth Freedom (PPO) plan covers dental services, including oral exams with a $30 copay, dental x-rays, and other diagnostic, preventative, and restorative services with no copay. This plan has a maximum benefit of $3,000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the eternalHealth Freedom (PPO) plan, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the eternalHealth Freedom (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME), prosthetics/medical supplies, and diabetic equipment. Durable medical equipment has a 20% coinsurance, and requires authorization and may be limited to preferred vendors, and DME for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, while diabetic supplies have a 0-20% coinsurance, and diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services and all radiological services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $10, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $250 (minimum $150), Therapeutic Radiological Services have a copay of $60, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered under the eternalHealth Freedom (PPO) plan, with no copay or coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered by the eternalHealth Freedom (PPO) plan, but none of the sub-services are covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the eternalHealth Freedom (PPO) plan. There is no copay for days 1-20, but there is a $203 copay for days 21-100; additional days beyond Medicare and non-Medicare-covered stays are not covered.
Other Services See details
Under "Other Services," the eternalHealth Freedom (PPO) plan covers acupuncture with a $25 copay, limited to 20 treatments per year, and over-the-counter items with a maximum benefit of $55 every three months. This plan also offers a meal benefit for chronic illness and does not cover Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management, Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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