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Simply Freedom (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Freedom (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Freedom (PPO) in 2025, please refer to our full plan details page.
Simply Freedom (PPO) is a PPO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Broward, Miami-Dade, Palm Beach. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Simply 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 Simply 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 Simply 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 $125.00 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 $5450.00 (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 $5450.00 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 Simply Freedom (PPO) plan has an "Enhanced Alternative" drug benefit type. The plan has a $125 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $10 copay at preferred and standard pharmacies, and no copay at standard mail order pharmacies. The plan provides no copay for specialty tier drugs.
Additional Benefits
The Simply Freedom (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, but many outpatient services, including primary care, preventive services, and vision services, have no copay. Dental services are covered with no copay up to an annual maximum, and the plan also includes home health services with no copay. Additional benefits include coverage for ambulance services, emergency services, and hearing services, with some services requiring a copay or coinsurance. The plan also covers home infusion services, dialysis, and medical equipment with varying cost-sharing. The plan offers an OTC benefit with a monthly maximum, and covers skilled nursing facility services with a copay after the first 20 days.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric, are covered by the Simply Freedom (PPO) plan. For inpatient hospital acute and psychiatric services, you will have a $280 copay for days 1-5, and no copay for days 6-90. Additional days and non-Medicare-covered stays for both acute and psychiatric services are not covered.
Outpatient Services See details
Outpatient Services, offered by Simply Freedom (PPO), cover all outpatient hospital services with a copay between $0 and $250, observation services with a $250 copay, ambulatory surgical center (ASC) services with no copay, outpatient substance abuse services with a $35 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Simply Freedom (PPO) plan, but requires prior authorization. You will have a $35 copay for this service.
Ambulance and Transportation Services See details
The Simply Freedom (PPO) plan covers ambulance services, but requires prior authorization. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the Simply Freedom (PPO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $135 copay, while Urgently Needed Services has a $40 copay. The plan has a maximum benefit coverage of $100,000 for Worldwide Emergency Services.
Primary Care See details
The Simply Freedom (PPO) plan covers primary care physician services and chiropractic services with no copay. Occupational therapy services, physician specialist services, physical therapy, and speech-language pathology services have a $35 copay. Individual and group sessions for mental health and psychiatric specialty services have a $35 copay. Other health care professional and additional telehealth benefits have no copay. Opioid treatment program services have a minimum and maximum copay of $35. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered zero dollar preventive services. Some services are not covered, including annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, telemonitoring services, home and bathroom safety devices and modifications, and counseling services. Other covered preventive services, such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, have no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams and routine hearing exams have no copay. Fitting/evaluation for hearing aids has no copay. Prescription hearing aids (all types) have no copay. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear, with routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames covered with no copay. Eyewear upgrades are not covered, but the plan offers a combined maximum of $200.00 every year for eyewear.
Dental Services See details
Dental services are covered under the Simply Freedom (PPO) plan, with a $2,500 annual maximum benefit. Diagnostic and preventive services, including oral exams, X-rays, cleanings, and fluoride treatments, have no copay, and other dental services, including restorative services, endodontics, and oral surgery, also have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Simply Freedom (PPO) plan, with a $35 copay for Medicare Part B Insulin Drugs. Other Medicare Part B drugs have a coinsurance between 0% and 20% and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Simply Freedom (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered. Durable Medical Equipment (DME) has a coinsurance of 0% to 20%, and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a 20% coinsurance and no copay. Diabetic Equipment is covered with no copay for diabetic supplies and diabetic therapeutic shoes/inserts, and the plan requires prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $25, Lab Services have no copay, Diagnostic Radiological Services have a copay of up to $150, Therapeutic Radiological Services have a copay of up to $60, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Simply Freedom (PPO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, SET for PAD Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Simply Freedom (PPO) plan. For days 1-20, there is no copay, but for days 21-100, the copay is $196. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Simply Freedom (PPO) plan covers Over-the-Counter (OTC) Items with no copay, up to a maximum of $72.00 per month, and includes Nicotine Replacement Therapy (NRT) as a Part C OTC benefit. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), 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 are not covered.
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