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Ochsner Health Plan Freedom (HMO POS)

The Freedom Plan allows you to get care from doctors, hospitals, pharmacies and other providers inside their network (called “in-network”), or, from outside their network. The difference is that if you use in-network providers, you’ll typically pay less in out-of-pocket costs. If you use out-of-network providers, you’ll still get some coverage from the plan, but your out-of-pocket costs will be higher.

To join Ochsner Health Plan Freedom, you must be entitled to Medicare Part A, be enrolled in Medicare Part B and live in our service area. Our service area includes the following Louisiana Parishes: Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Lafourche, Livingston, Orleans, St. Charles, St. John the Baptist, St. Tammany, West Baton Rouge.

Premium and Benefit Detail

This is a summary of drug and health services covered by Ochsner Health Plan Freedom (HMO POS), Jan. 1, 2022 - Dec. 31, 2022. 

Premium Benefits

Ochsner Health Plan Freedom  (HMO POS) 

What You Should Know
Monthly Plan Premium  You pay $0  You must continue to pay your Medicare Part B premium. 
Part B Premium Reduction  N/A  There is no Part B reduction. 
Annual Medical Deductible  $0  There is no medical deductible 

Maximum Out-of-Pocket Responsibility (does not include prescription drugs or out-of-network services

$3,700 annually 

The most you pay for copays, coinsurance, and other costs for in-network medical services in a year.

Inpatient Hospital 

In-network: $65 each day for 1 through 7 days; $0 for 8 through 90 days 

You pay these amounts until you reach the in-network out-of-pocket maximum. 

Our plan covers an unlimited number of days for inpatient hospital stays. 

Your provider may need to obtain prior authorization. 

Out-of-network: 20% per stay

Outpatient Hospital 

  • Ambulatory Surgery Center 

In-network: $160 copay per visit 

$0 copay for diagnostic colonoscopy at an in-network facility 

Your provider may need to obtain prior authorization. 
Out of network: 20% coinsurance per visit 
  • Outpatient Hospital Including Surgery 

In-network: $130 copay per visit 

Your provider may need to obtain prior authorization. 
Out-of-network: 20% coinsurance per visit 
  • Outpatient Observation Services 

$0 copay 

Your provider may need to obtain prior authorization. 
Out-of-network: 20% coinsurance per visit 
Doctor Visits
  • Primary Care 

In-network: $0 copay 

 
Out-of-network: 20% coinsurance per visit 
  • Specialist Care 

In-network: $20 copay per visit 

 
Out-of-network: 20% coinsurance per visit 

Preventive Care (flu vaccine, COVID-19 vaccine, diabetic screenings, etc.) 

In-network: $0 copay 

Any additional preventive services approved by Medicare during the contract year will be covered.  
Out-of-network: 20% coinsurance 
Emergency Care  $90 copay per visit (for both in-network and out-of-network)  If you are admitted to the hospital within 1 day, the emergency room copay is waived. 
Urgently Needed Services  $20 copay per visit (for both in-network and out-of-network)  If you are admitted to the hospital within 1 day, the urgent care copay is waived. 
Diagnostic Services/Labs/Imaging 
  • Diagnostic Radiology Services (MRI, etc) 

In-network: $0-$85 copay 

$0 copay for diagnostic mammogram 

Your provider may need to obtain prior authorization. 
Out-of-network: $20 coinsurance 
  • Lab Services 

In-network: $0 copay 

Your provider may need to obtain prior authorization. 
Out-of-network: 20% coinsurance 
  • Diagnostic Tests and Procedures 
In-network: $35 copay  Your provider may need to obtain prior authorization. 
Out-of-network: 20% coinsurance 
  • Therapeutic Radiology 
In-network: $35 copay  Your provider may need to obtain prior authorization. 
Out-of-network: 20% coinsurance 
  • Outpatient X-Rays 
In-network: $35 copay  Your provider may need to obtain prior authorization. 
Out-of-network: 20% coinsurance 
Hearing Services
  • Exam to diagnose and treat hearing and balance issues 
In-network: $20 copay   
Out-of-network: 20% coinsurance 
  • Routine Hearing Exam 
In-network: $20 copay  1 routineexam every year. 
Out-of-network: 20% coinsurance 
  • Hearing Aids 
In-network: $0 copay  Plan pays up to $500 for each ear per year. 
$1000 allowance every year 
Dental Services 
  • Medicare Covered 
In-Network: $20 copay  Medicare-covered Benefits limited to services provided under the Medicare program.  
Out of Network: 20% coinsurance 
  • Preventive Dental 
In-network: $0 copay for oral exams, cleaning and x-rays.  Preventive Dental (oral exams, cleaning, and dental x-ray) each service limited to 2 treatments per year
  • Comprehensive Dental 
In-network: $50 deductible applies before coverage begins. 

Comprehensive Dental - Restorative Services; Endodontics; Periodontics; Extractions; Prosthodontics, Other Oral/Maxillofacial Surgery, Other Services 

Comprehensive and Preventive dental services are limited to up to $2000 in total combined cost per year. 

In-network:  $0 copay for diagnostic services 
In-network:  $11- $295 copay for restorative services 
In-network:  $15 for extractions 
In-network:  $20-$217.75 copay for prosthetics, other oral/maxillofacial surgery, & other services 
Vision Services
  • Exam to diagnose and treat conditions and diseases of the eye 
In-network: $20 copay  
Out-of-network: 20% coinsurance 
  • Eyewear post-cataract surgery 
In-network: $0 copay  
Out-of-network: 20% coinsurance 
  • Routine Eye Exam 
In-network: $0 copay 1 routine exam per year 
Out-of-network: 20% coinsurance 
  • Eyewear 
In-network: $0 copay Eyewear - Up to $200 every year
Mental Health Services 
  • Inpatient visit 
$65 copayment each day for days 1     to 10 for Medicare-covered hospital care. $0 copayment for additional Medicare-covered days.   
Out-of-network: 20% coinsurance 
  • Outpatient Group Therapy Visit 
In-network: $20 copay   
Out-of-network: 20% coinsurance 
  • Outpatient Individual Therapy Visit 
In-network: $20 copay   
Out-of-network: 20% coinsurance 
  • Skilled Nursing Facility (SNF) 
In-network: $0 per day for 1 through 20, $178 per day for days 21 through 100 

Our plan covers up to 100 days in a SNF. 

0 hospital days required prior to SNF admission. 

Out-of-network: 20% per day 
Rehabilitative Services 
  • Occupational Therapy Visit 
In-network: $20 copay   
Out-of-network: 20% coinsurance 
  • Physical Therapy and Speech and Language Therapy Visit 

In-network: $20 copay   
Out-of-network: 20% coinsurance 
Ambulance  In-network: $235 copay for ground ambulance  Prior authorization may be required for Medicare-covered non-emergent ambulance. 
Out-of-network: 20% coinsurance for ground ambulance 
20% coinsurance for air ambulance 
Transportation  Not Covered   
Medicare Part B Drugs  You pay 20% of the cost for   Medicare-covered services  Prior authorization is required for billed charges over $250. 
Home Health Services 

In-network: $0 copay

Prior Authorization required. 
Out-of-network: 20% coinsurance 
Foot Care (Podiatry) 

In-network: $20 copay per visit 

Limited to 6 routine podiatry services per year. 
Out-of-network: 20% coinsurance per visit 
Medical Equipment/Supplies 
  • Durable Medical Equipment (wheelchairs, oxygen, etc.) 
  • Prosthetics (braces, artificial limbs, etc) 

  • Diabetes Supplies 

In-network: 0-20% coinsurance per item 

Out-of-network: 20% coinsurance per item 

Prior authorization is required for billed charges over $250. 

Over-the-Counter (OTC) Items  You pay $0 for up to $75 per quarter of covered items. 

Plan provides $75 per quarter allowance for OTC item, and you must use those funds in that quarter; you can’t carry them forward. 

Items must be on the list provided by Plan and purchased from Plan’s contracted vendor. 

Chiropractic Care 

In-network: $20 copay per visit 

Includes manual manipulation of the spine to correct subluxation.
Out-of-network: 20% coinsurance per visit 
Diabetes Management 
  • Diabetes Monitoring Supplies 
In-network: $0 copay per item   

Out-of-network: 20% coinsurance per item 

  • Diabetes Self-management Training 
In-network: $0 copay per item   

Out-of-network: 20% coinsurance per item 

  • Therapeutic Shoes or inserts 

In-network: $0 copay per item 

 

Out-of-network: 20% coinsurance per item 

Health Education  In-network: $0 copay Get help over the phone from a clinical team who can help you manage chronic conditions.  
Fitness Program  In-network: $0 copay Must use an in-network fitness facility. 
Meal Benefit  In-network: $0 copay 

For use immediately following surgery or inpatient hospital stay. Nutritional need must meet CMS criteria. 

Allowance: 2 meals per day for 7 days per Medicare-covered inpatient discharge. No maximum number of meals per year. 

Hospice  You pay nothing for hospice care from any Medicare-approved hospice You may have to pay part of the costs for drugs and respite care.  Hospice is covered by Original Medicare, outside of our plan. 
Opioid Treatment Services  In-network: $0 copay Must be provided by a CMS certified Opioid Treatment Services Program. 
Out-of-network: 20% coinsurance 
Outpatient substance abuse treatment – group or individual In-network; $20 copay  
Out-of-network: 20% coinsurance 
Renal dialysis  In-network; $20 copay  
Out-of-network: 20% coinsurance 

 

Prescription Drugs

Stage 1: Annual Prescription Deductible

Since you have no deductible for Part D drugs, this payment stage doesn't apply

Stage 2:  Initial Coverage (After you pay your deductible, if applicable)  Retail Mail Order
30-day supply 90-day supply 90-day supply
Tier 1: Preferred Generic Drugs $0 copay  $0 copay  $0 copay 

Tier 2: Generic Drugs1

$10 copay  $0 copay  $0 copay 

Tier 3: Preferred Brand Drugs 

$45 copay  $135 copay  $135 copay 
Select Insulin Drugs2 $35 copay  $105 copay  $105 copay 

Tier 4: Non-Preferred Brand Drugs 

$100 copay  $300 copay  $300 copay 

Tier 5: Specialty Tier Drugs 

33% coinsurance  N/A3 N/A3

Stage 3: Coverage Gap Stage 

Tier 1 and Tier 2 Drugs are covered in the gap. For covered drugs on other tiers, after your total drug costs reach $4,430, you pay 25% coinsurance for generic drugs and 25% coinsurance for brand name drugs during the coverage gap. 
Stage 4:  Catastrophic Coverage   After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050, you pay the greater of:  $3.95 for those generic or preferred multisource drugs with a retail price under $79 and 5% for those with a retail price greater than $79. For brand-name drugs, you would pay $9.85 for those drugs with a retail price under $197 and 5% for those with a retail price over $197. 

Other Limitations May Apply

1Tier includes enhanced drug coverage 

2 For 2022, this plan participated in the Insulin Senior Savings Program which offers lower, stable, and predictable out of pocket costs for covered insulin through the different Part D benefit coverage stages. You will pay a maximum of $35 for a 1-month supply of covered Senior Savings Program insulin during the deductible, initial coverage, and coverage gap or “donut hole” stages of your benefit. You will pay 5% of the cost of these covered insulin in the catastrophic stage. Your cost maybe less if you receive Extra Help from Medicare. 

3 Limited to a 30-day supply.   

Need More Details?

The information on these pages is just a summary of what the plan covers and what you’ll pay. It doesn’t list every possible service, or every limitation or rule. If you’d like a complete list of all services, please call Member Services toll-free at 833-674-2112. Just ask for “Evidence of Coverage.”

We are open:

  • Oct. 1 to Mar. 31: 8 a.m. to 8 p.m., seven days a week
  • Apr. 1 to Sept. 30: 8 a.m. to 8 p.m., Monday through Friday

TTY users: Please call 711 or visit www.ochsnerhealthplan.com.

Ready to Enroll?

Starting Oct. 15, 2021 you can enroll online or call 855-431-3423 to speak with an enrollment specialist from Ochsner Health Plan.