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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 Orange, Osceola, Seminole, Volusia. 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 will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $10 copay, while standard generic drugs have a $42 or $47 copay. For preferred brand drugs and non-preferred drugs, you will pay 25% and 31% coinsurance, respectively. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered 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 dental services, have no copay. Emergency services and diagnostic services have copays, and ambulance services have copays or coinsurance. This plan also includes coverage for vision, hearing, and home health services with no copays in some instances. Medical equipment, home infusion, and dialysis services are covered with coinsurance. Additionally, this plan covers OTC items with a monthly allowance, and skilled nursing facility stays have a copay after the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization. For the first 5 days of Inpatient Hospital-Acute and Inpatient Hospital Psychiatric stays, there is a $275 copay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
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, and Ambulatory Surgical Center (ASC) Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $35. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Simply Freedom (PPO) plan, with a $35 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Simply Freedom (PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $240 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 $120 copay, and Urgently Needed Services has a $40 copay; all have no coinsurance.
Primary Care See details
The Simply Freedom (PPO) plan covers primary care physician services and chiropractic services with no copay, and covers occupational therapy services with a $35 copay. Physician specialist services and physical therapy/speech-language pathology services have a $35 copay, and other health care professional services have no copay. The plan also covers mental health and psychiatric services with a $35 copay for individual and group sessions, and additional telehealth benefits with no copay.
Preventive Services See details
Preventive Services are covered, including services not usually covered by Medicare plans. Medicare-covered preventive services have no copay and require prior authorization, while the annual physical exam is not covered. Other covered services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following 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, and fitting/evaluation for hearing aids have no copay, but prescription hearing aids have a copay; OTC hearing aids are not covered.
Vision Services See details
The Simply Freedom (PPO) plan covers vision services, including routine eye exams and eyewear. Routine eye exams and eyewear have no copay, and the plan covers one routine eye exam per year and allows for a $200 combined maximum for eyewear every year.
Dental Services See details
The Simply Freedom (PPO) plan covers a variety of dental services including exams, x-rays, and cleanings with no copay, with a maximum benefit of $2,000 per year. Additional services such as restorative services, orthodontics, and more are also covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Simply Freedom (PPO) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs, with a coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Simply Freedom (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered by the Simply Freedom (PPO) plan, with Durable Medical Equipment covered with a coinsurance between 0% and 20%, and no copay. Prosthetics, medical supplies, and diabetic equipment are also covered, and medical supplies have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay required for some services. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $150 and Therapeutic Radiological Services have a copay up to $60, while 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Simply Freedom (PPO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Simply Freedom (PPO) plan, but require prior authorization. For days 1-20, there is no copay, while days 21-100 have a $196 copay; this plan does not cover additional days beyond Medicare-covered for SNF or non-Medicare-covered stays.
Other Services See details
The Simply Freedom (PPO) plan covers Over-the-Counter (OTC) Items with no copay, up to a maximum of $45.00 every month, and also covers 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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