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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 2026, 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 2026.
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 $9500.00 (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 $9500.00 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) Medicare plan features an annual prescription drug deductible of $185. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic medications, copays are highly affordable, starting at just $5 for a one-month supply. For higher-tier medications, costs are based on a coinsurance percentage rather than a flat copay. You can expect a 25% coinsurance for Tier 3 preferred brand drugs and a 40% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply at standard pharmacies and standard mail order.
Additional Benefits
The eternalHealth Freedom (PPO) plan offers comprehensive medical coverage with no copays or coinsurance for primary care, specialist, and telehealth visits. For inpatient hospital stays, members pay a $370 daily copay for the first five days and no copay for days six through 90, while outpatient hospital services range from no copay to a $350 copay. Emergency room visits carry a $125 copay, which is waived if admitted, and urgent care ranges from no copay to a $25 copay. Preventive and comprehensive dental services are covered with no copay up to a $2,500 annual limit, while routine eye and hearing exams require a $35 copay. The plan also features no copays for home health care, lab services, and up to 24 one-way health-related transportation trips per year. Additionally, members benefit from a $60 over-the-counter allowance every three months and chronic illness meals with no copay.
Inpatient Hospital See details
eternalHealth Freedom (PPO) covers inpatient hospital services with no coinsurance, requiring a $370 daily copay for days 1 to 5 and no copay for days 6 to 90 per stay. The benefit is partially covered because non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
eternalHealth Freedom (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services carry a $0 to $350 copay, observation services require a $350 copay per stay, and outpatient substance abuse sessions have a $30 copay.
Partial Hospitalization See details
eternalHealth Freedom (PPO) covers partial hospitalization services with a $25.00 copay and no coinsurance.
Ambulance and Transportation Services See details
eternalHealth Freedom (PPO) covers ground and air ambulance services with a $300 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by eternalHealth Freedom (PPO) with a $125 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed and worldwide emergency services require no coinsurance and no deductibles, with copays ranging from no copay to $25 for urgent care, and up to a $300 copay for worldwide emergency transportation under a $25,000 maximum benefit.
Primary Care See details
eternalHealth Freedom (PPO) covers primary care, specialist, and telehealth visits with no copay and no coinsurance, while physical, occupational, and speech therapy services require a $20 copay and no coinsurance. Mental health, psychiatric, and opioid treatments feature no coinsurance and copays up to $30, though routine chiropractic is only partially covered with a $25 copay (up to 20 visits), and podiatry and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by eternalHealth Freedom (PPO) with no copay and no coinsurance, including annual physicals, kidney disease education, and glaucoma screenings. Additional preventive services are partially covered, offering a fitness benefit but excluding health education, weight management, in-home safety assessments, medical nutrition therapy, and personal emergency response systems.
Hearing Services See details
eternalHealth Freedom (PPO) partially covers hearing services, offering hearing exams and evaluations for a $35 copay and no coinsurance, and up to two prescription hearing aids per year with a $595 to $895 copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision Services are partially covered by eternalHealth Freedom (PPO), providing one annual routine eye exam with a $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is also partially covered with no copay or coinsurance up to a $200 yearly limit for contacts or eyeglasses, though upgrades are excluded.
Dental Services See details
eternalHealth Freedom (PPO) covers Medicare-covered dental services for a $35 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance. These additional services, which include exams, cleanings, and implants, are subject to a combined in-network and out-of-network annual maximum benefit of $2,500.
Home Infusion bundled Services See details
eternalHealth Freedom (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs feature no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the eternalHealth Freedom (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
eternalHealth Freedom (PPO) covers medical equipment with no copays, requiring a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are also covered with no copay and carry a coinsurance ranging from no coinsurance up to 20%, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by eternalHealth Freedom (PPO) with no coinsurance, though prior authorization is required. Lab services feature no copay, diagnostic tests have a copay of $0 to $10, outpatient X-rays cost a $15 copay, and therapeutic and diagnostic radiological services require minimum copays of $60 and $100, respectively.
Home Health Services See details
Home Health Services are covered under the eternalHealth Freedom (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered under the eternalHealth Freedom (PPO) plan, which only covers Additional Cardiac Rehabilitation Services with a $25 copay and no coinsurance. Standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
eternalHealth Freedom (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $203 daily copay for days 21 through 100, with additional days beyond the Medicare-covered limit not covered.
Other Services See details
eternalHealth Freedom (PPO) covers acupuncture with a $25 copay and no coinsurance for up to 20 treatments per year, as well as chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are also covered with no copay and no coinsurance, offering up to $60 every three months in reimbursement for eligible health products.
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