Simply Freedom (PPO)

Plan too new to be measured* for plan year 2023

$0.00 Monthly Premium

Simply Freedom (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Simply Healthcare

Plan ID: H9469-009-000

$0.00 Monthly Premium

Florida Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.

Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.

Learn more about Florida Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Basic Costs and Coverage

Coverage	Details
Monthly plan premium	$0.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible	$125.00
Out-of-pocket maximum	$5,000.00
Initial drug coverage limit	$0.00
Catastrophic drug coverage limit	$7,400.00
Primary care doctor visit	In-Network: $0.00 copay
Specialty doctor visit	In-Network: $35.00 copay
Inpatient hospital care	Out-of-Network: 40% coinsurance per stay
Urgent care	Urgent Care: $40.00 copay Urgently Needed Services Copay Waived with Inpatient Admission
Emergency room visit	Emergency Care: $90.00 copay Copay waived if admitted to hospital within 24 Hours Worldwide Coverage: This plan covers urgent care and emergency services when traveling outside of the United States for less than six months. This benefit is limited to $100,000.00 per year.
Ambulance transportation	Ground Ambulance: $240.00 copay Per Trip Air Ambulance: $240.00 copay

Health Care Services and Medical Supplies

Simply Freedom (PPO) covers a range of additional benefits. Learn more about Simply Freedom (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage	Details
Chiropractic services	In-Network: Medicare Covered Chiropractic Services: $0.00 copay
Diabetes supplies, training, nutrition therapy and monitoring	Out-of-Network: 40% coinsurance
Durable medical equipment (DME)	In-Network: 0% - 20% coinsurance depending on the equipment
Diagnostic tests, lab and radiology services, and X-rays	In-Network: Lab Services: $0.00 copay X-Rays: $0.00 - $25.00 copay Therapeutic Radiological Services: $0.00 - $60.00 copay Outpatient Diagnostic Procedures/Tests: $0.00 - $25.00 copay Diagnostic Radiological Services: $0.00 - $150.00 copay
Home health care	In-Network: $0.00 copay
Mental health inpatient care	Out-of-Network: 40% coinsurance per stay
Mental health outpatient care	In-Network: Individual and Group Sessions: $35.00 copay
Outpatient services/surgery	Out-of-Network: Outpatient Hospital - Surgery: 40% coinsurance Observation Services: 40% coinsurance Ambulatory Surgical Center: 40% coinsurance
Outpatient substance abuse care	Out-of-Network: 40% coinsurance
Over-the-counter items	This plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $40 every month. Unused OTC amounts do not roll over from month to month.
Podiatry services	In-Network: Medicare Covered Podiatry Services: $35.00 copay
Skilled Nursing Facility (SNF) care	In-Network: SNF Days 1 - 20: $0.00 per day / Days 21 - 100: $196.00 per day

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Dental care	In-Network: Preventive Dental Services: $0.00 copay This plan covers: 2 Exams, 2 Prophylaxis cleanings, 2 Series of bitewing films, and 1 Panoramic film every year. Medicare Covered Dental: $0.00 copay Comprehensive Dental Services: $0.00 copay This plan covers up to a $2,000.00 allowance for covered comprehensive dental services every year.

Vision Benefits

The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Vision benefits	Out-of-Network: Medicare Covered Eye Exam: $70.00 copay Routine Eye Exam: $0.00 copay Medicare Covered Eye Wear: $70.00 copay Routine Eye Wear: $0.00 copay

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Hearing benefits	Out-of-Network: Medicare Covered Hearing Exam: $70.00 copay Routine Hearing Exam: 50% coinsurance for routine hearing exam(s).

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Preventive services and health/wellness education programs	Out-of-Network: 40% coinsurance

Prescription Drug Costs and Coverage

The Simply Freedom (PPO) offers prescription drug coverage, with an annual drug deductible of $125.00 (excludes Tiers 1, 2 and 3)

Coverage	Cost
Coverage & Cost
Annual drug deductible	$125.00 (excludes Tiers 1, 2 and 3)
Tier 1	Standard retail $0.00 Standard mail order $0.00
Tier 2	Standard retail $10.00 Standard mail order $0.00
Tier 3	Standard retail $47.00 Standard mail order $47.00
Annual drug deductible	$125.00 (excludes Tiers 1, 2 and 3)
Tier 1	Standard retail $0.00 Standard mail order $0.00
Tier 2	Standard retail $20.00 Standard mail order $0.00
Tier 3	Standard retail $94.00 Standard mail order $141.00
Annual drug deductible	$125.00 (excludes Tiers 1, 2 and 3)
Tier 1	Standard retail $0.00 Standard mail order $0.00
Tier 2	Standard retail $30.00 Standard mail order $0.00
Tier 3	Standard retail $141.00 Standard mail order $141.00

When reviewing Florida Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

You may be able to find plans in your part of Florida that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.