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Simply Freedom (PPO) - H9469-002-000
$0.00
Monthly Premium
Simply Freedom (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Simply Healthcare
Plan ID: H9469-002-000
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$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.
Enrollment may be limited to certain times of the year. See why you may be able to enroll.
Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $0.00 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $150.00 |
| Out-of-pocket maximum | $4,500.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $2,000.00 |
| Primary care doctor visit | Out-of-Network: $40.00 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: $120.00 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 per year. |
| Ambulance transportation | Ground Ambulance: $260.00 copay Per Trip Air Ambulance: 20% coinsurance |
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 | Out-of-Network: Medicare Covered Chiropractic Services: 40% coinsurance |
| Diabetes supplies, training, nutrition therapy and monitoring | In-Network: Diabetic Supplies: $0.00 copay |
| Durable medical equipment (DME) | Out-of-Network: 40% coinsurance |
| Diagnostic tests, lab and radiology services, and X-rays | Out-of-Network: Lab Services: 40% coinsurance X-Rays: 40% coinsurance Therapeutic Radiological Services: 40% coinsurance Outpatient Diagnostic Procedures/Tests: 40% coinsurance Diagnostic Radiological Services: 40% coinsurance |
| 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 | In-Network: Outpatient Hospital - Surgery: $250.00 copay Observation Services: $250.00 copay Ambulatory Surgical Center: $150.00 copay |
| 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 $55 every month. Unused OTC amounts expire at the end of each month. |
| Podiatry services | In-Network: Medicare Covered Podiatry Services: $35.00 copay |
| Skilled Nursing Facility (SNF) care | In-Network: 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 | Out-of-Network: Medicare Covered Dental: $70.00 copay Non-Medicare Preventive Dental Services: 50% coinsurance Non-Medicare Comprehensive Dental Services: 50% coinsurance |
Vision Benefits
The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage
| Coverage | Details |
|---|---|
| Vision care | 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 care | 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 $150.00 (excludes Tiers 1, 2, and 6)
Coverage & Cost | |
|---|---|
| Coverage | Cost |
| Annual drug deductible | $150.00 (excludes Tiers 1, 2, and 6) |
| Tier 1 |
|
| Tier 2 |
|
| Tier 6 |
|
| Annual drug deductible | $150.00 (excludes Tiers 1, 2, and 6) |
| Tier 1 |
|
| Tier 2 |
|
| Tier 6 |
|
| Annual drug deductible | $150.00 (excludes Tiers 1, 2, and 6) |
| Tier 1 |
|
| Tier 2 |
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| Tier 6 |
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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.
Plan Documents
| Links to plan documents |
Florida Counties Served
We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield*, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.