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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 Brevard, Indian River, Martin, St. Lucie. 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. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 $150.00 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 $8950.00 (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 $8950.00 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 a $150 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $10 copay at preferred and standard pharmacies, while standard mail order has no copay. In the initial coverage phase, you'll pay these costs until your total drug costs reach $2000. Once you reach this amount, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Simply Freedom (PPO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services can range from no copay to a $250 copay. Emergency services have a copay, and primary care, including chiropractic services, has no copay. This plan includes coverage for hearing, vision, and dental services, with no copays for many of these services. Additionally, the plan covers home health services and skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered under the Simply Freedom (PPO) plan. For days 1-5, there is a $295 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services are covered by the Simply Freedom (PPO) plan. Outpatient Hospital Services have a copay between $0 and $250, Observation Services have a $250 copay, Ambulatory Surgical Center (ASC) Services have no copay, Individual and Group Sessions for Outpatient Substance Abuse have a copay of $35, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Simply Freedom (PPO) plan, but requires prior authorization. You will have a $35 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Simply Freedom (PPO) plan. Ground ambulance services have a $260 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency Services are covered by the Simply Freedom (PPO) plan, with a $120 copay and no coinsurance. Urgently Needed Services have a $40 copay and no coinsurance. Worldwide Emergency Services are covered with a $120 copay and no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, with a maximum plan benefit of $100,000.
Primary Care See details
The Simply Freedom (PPO) plan covers primary care physician services and chiropractic services with no copay, and occupational therapy services with a $35 copay. Physician specialist services cost a $35 copay, while individual and group sessions for mental health and psychiatric services have a $35 copay. Physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have no copay. Opioid treatment program services have a $35 copay, and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar preventive services; however, annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. Fitness benefits, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits have no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have no copay, and a maximum benefit coverage of $59 per year. Routine hearing exams and fitting/evaluation for hearing aids have no copay, with a limit of one visit per year. Prescription hearing aids are covered up to $2000 per year, with no copay for prescription hearing aids of all types, but prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Vision Services are covered, including eye exams and eyewear. Eye exams have no copay, and eyewear also has no copay. Routine eye exams are covered once per year, and eyewear has a combined maximum benefit of $200 every year.
Dental Services See details
Dental Services are covered, with a $1,500 annual maximum benefit. Medicare Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Simply Freedom (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a coinsurance between 0% and 20%, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Simply Freedom (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $25, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $150, Therapeutic Radiological Services have a maximum copay of $60, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Simply Freedom (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Simply Freedom (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Simply Freedom (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $196.
Other Services See details
Simply Freedom (PPO) covers Over-the-Counter (OTC) Items with no copay and a maximum plan benefit coverage amount of $55.00 every month. However, acupuncture, meal benefits, 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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