eternalHealth Freedom (PPO)
Massachusetts Medicare Advantage Plan (2024 Plan)
Additional Coverage
HearingVisionDental
Overall Government Star Rating
No Rating (new plan)
Plan Name
eternalHealth Freedom (PPO)
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
eternalHealth Freedom (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Massachusetts and offered by the health insurance company eternalHealth. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$100 copay per visit (always covered)
eternalHealth Freedom (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $9,000 In and Out-of-network
$6,000 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for eternalHealth Freedom (PPO) are defined below.
Yes
Part D Prescription Drug Coverage
eternalHealth Freedom (PPO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. eternalHealth Freedom (PPO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. eternalHealth Freedom (PPO) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Health Portion of Premium
Health Plan Max Out-of-Pocket
$9,000 In and Out-of-network
$6,000 In-network
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: $0 copay
Out-of-network: $20 copay per visit
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: $0-30 copay
Out-of-network: 30% coinsurance
Lab services
In-network: $0-10 copay
Out-of-network: 30% coinsurance
Diagnostic radiology services (like MRI)
In-network: $150-300 copay
Out-of-network: 30% coinsurance
Outpatient x-rays
In-network: $15 copay
Out-of-network: 30% coinsurance
Emergency care
$100 copay per visit (always covered)
Urgent care
$0-25 copay per visit (always covered)
Hospital Services
Inpatient hospital coverage
In-network: $370 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: 40% per stay
Outpatient hospital coverage
In-network: $0-350 copay per visit
Out-of-network: 40% coinsurance per visit
Skilled nursing facility
Skilled nursing facility
In-network: $0 per day for days 1 through 20
$203 per day for days 21 through 100
Out-of-network: 30% per stay
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: 30% coinsurance
Ambulance
Ground ambulance
In-network: $300 copay
Out-of-network: $300 copay
Therapy services
Occupational therapy visit
In-network: $40 copay
Out-of-network: 30% coinsurance
Physical therapy & speech & language therapy visit
In-network: $40 copay
Out-of-network: 30% coinsurance
Mental health services
Outpatient group therapy with a psychiatrist
In-network: $0-25 copay
Out-of-network: 30% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: $0-25 copay
Out-of-network: 30% coinsurance
Outpatient group therapy visit
In-network: $0-25 copay
Out-of-network: $50 copay
Outpatient individual therapy visit
In-network: $0-25 copay
Out-of-network: $50 copay
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Diabetes supplies
In-network: 0-20% coinsurance per item
Out-of-network: 30% coinsurance per item
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
|---|
| Preferred Generic | $0.00 copay |
Generic drugs :
25% Brand-name drugs :
25% |
Generic drugs :
$0 copay Brand-name drugs :
$0 copay |
| Generic | $5.00 copay |
| Preferred Brand | $47.00 copay |
| Non-Preferred Drug | $100.00 copay |
| Specialty Tier | 30% |
Part B Drugs
Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: 30% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 30% coinsurance
Hearing
Hearing exam
In-network: $15 copay
Out-of-network: 50% coinsurance
Hearing aids - All types
In-network: $595-895 copay
Out-of-network: 50% coinsurance
Preventive Dental
Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Non-routine services
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic services
In-network: $0 copay
Out-of-network: $0 copay
Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Extractions
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services
In-network: $0 copay
Out-of-network: $0 copay
Vision
Routine eye exam
In-network: $0 copay
Out-of-network: 50% coinsurance
Contact lenses
In-network: $0 copay
Out-of-network: 50% coinsurance
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: 50% coinsurance
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: 50% coinsurance
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: 50% coinsurance
Upgrades
In-network: $0 copay
Out-of-network: 50% coinsurance
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