Ochsner Health Plan 2025 Heroes (HMO POS) H9763-006 | Medicare Advantage plan without part d drug coverage
Baton Rouge and New Orleans Region
Medicare Advantage plan available in these 11 parishes: Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Lafourche, Livingston, Orleans, Plaquemines, St. Bernard, St. Charles, St. John, West Baton Rouge
Get more than Original Medicare with these great benefits.
Plan Documents
Plan Benefits
| Ochsner Health Plan Heroes (HMO POS) H9763-006 | Your Cost |
| Monthly Plan Premium | $0 |
| Part B Premium Give Back | $100 per month |
| Medicare Part D Prescription Drug Coverage | This plan does not include Part D coverage |
| Maximum Out of Pocket | $4,450 per year in network, $8,000 out of network |
| Doctor Visits | |
| Primary Care Physician Visit | $0 |
| Specialist Visit | $25 copay Out-of-network 20% coinsurance per visit |
| Chiropractic Care | $20 copay Out-of-network 30% coinsurance per visit |
| Preventive Care | |
| Pap Test, Pelvic Exams, Mammograms | $0 |
| Prostate and Colorectal Cancer Screenings | $0 |
| Vaccinations* | $0 |
| Labs & Tests | |
| Lab Services (at contracted lab provider) | $0 |
| Diagnostic Tests | $10 copay Out-of-network 20% coinsurance per visit |
| Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.) | $125 copay Out-of-network 20% coinsurance per visit |
| Therapeutic Radiology and Outpatient X-Rays | $50 copay Out-of-network 20% coinsurance per visit |
| Outpatient Surgery | |
| Surgery at Outpatient Hospital or Ambulatory Surgery Center | $175 copay You pay these amounts until you reach the out-of-pocket maximum. Out-of-network 30% coinsurance per visit. |
| Inpatient Hospital Stay | |
| Inpatient Deductible | $0 |
| Hospital Stay (days 1-10) | $175 copay Out-of-network 30% coinsurance per visit |
| Hospital Stay (days 11 and beyond) | $0 |
| Emergency and Urgent Care | |
| Urgent Care | $35 copay |
| Emergency Care | $140 copay |
| Emergency & Urgent Care | If you are admitted to the hospital within one (1) day, the copay is waived. Covered Worldwide |
| Emergency Ambulance Service (per one day trip, ground or air) | $235 ground 20% air |
| Outpatient Services & Supplies | |
| Diabetes Monitoring Supplies | $0 In-Network Pharmacy, 20% coinsurance from DME supplier. Out-of-network 30% coinsurance per item. |
| Occupational, Physical or Speech Therapy Visit | $20 copay Out-of-network 30% coinsurance per visit |
| Mental Health Treatment | |
| Inpatient Mental Health Care per Day | $175 per day for days 1-10 $0 for days 11-90 |
| Outpatient Mental Health Group or Individual Visit | $25 copay Out-of-network 30% coinsurance per visit |
| Additional Benefits Not Covered by Original Medicare | Your Cost |
| Over-the-Counter Health & Wellness Items | $85 credit per calendar quarter from OTC Catalog |
| Routine Vision Exam (1 per calendar year) | $20 copay for routine vision exam (through contracted provider). No out of network coverage. |
| Glasses or Contact Lenses | Up to $300 allowance per calendar year (through contracted provider). No out of network coverage. |
| Hearing aids, Routine hearing exams, Hearing aid fitting/evaluations | Routine hearing exams $20 copay. Up to $1,000 combined maximum allowance per calendar year (through contracted provider). All plans from Ochsner Health Plan include access to routine hearing care, including prescription hearing aids, routine hearing exams, and fittings/evaluations for hearing aids. As a member, you'll receive a Visa debit card preÂloaded with funds for you to use to pay for your hearing aids and exams. All plans from Ochsner Health Plan include access to routine hearing care, including prescription hearing aids, routine hearing exams, and fittings/evaluations for hearing aids. As a member, you'll receive a Visa debit card preÂloaded with funds for you to use to pay for your hearing aids and exams. |
| Dental Coverage - Preventive and Comprehensive | $0 copay for Medicare-covered visit. Up to $3,000 combined maximum allowance per calendar year for preventive and comprehensive dental services. You pay a 25% coinsurance for the following services (through a contracted provider): • Restorative services • Endodontics • Periodontic • Prosthodontics • Oral and Maxillofacial Surgery • Adjunctive General Services No out of network coverage. |
| Health Club Membership (Silver & Fit) Ochsner Fitness Centers included: Downtown, Harahan, Heritage Plaza | $0 copay (through contracted provider SilverSneakers). |
| Post Discharge Home Meal Delivery (inpatient hospital stay or skilled nursing facility stay) | $0 copay (through contracted provider). |
| Additional Benefits - Part D Drug Coverage | ||
| Part D Drug Coverage | No Part D coverage |
*Important Message About What You Pay for Vaccines-Our plan covers most Part D vaccines at no cost to you. Call our Pharmacy Help Desk for more information.1-800-910-1837, TTY users should call 711. Hours are 24 hours a day/365 days a year.
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