Plan Comparison
You can choose from two different plans: the Premier Plan (HMO) or the Freedom Plan (HMO POS).
Both plans offer generous benefits, but the Premier Plan offers up to $30 per month in Part B premium Give Back and the Freedom Plan offers the freedom of choice of an out-of-network option.
The Premier Plan is an HMO, which means you can only see doctors that are in the plan’s network; if you see out-of-network doctors, you may be responsible for the entire cost. The Freedom Plan is an HMO POS, which means you can also see doctors that aren’t in the plan’s network, but it may cost you more out-of-pocket.
2023 Benefit Comparison
Here’s an overview of how the plans compare. For more in-depth information on how each plan works, visit:
Premier Plan Details and Freedom Plan Details.
| PLAN | OHP PREMIER (HMO) H9763-003-001 |
OHP PREMIER (HMO) H9763-003-002 |
OHP FREEDOM (HMO POS) H9763-002 |
|---|---|---|---|
| 2023 Key Features | Comprehensive $2,000 Dental benefit, $0 copay PCP, OTC quarterly allowance, $30 premium reduction, MAPD | Comprehensive $2,000 Dental benefit, $0 copay PCP, OTC quarterly allowance, $17 premium reduction, MAPD | Comprehensive $2,000 Dental benefit, $0 copay PCP, OTC quarterly allowance, out of network benefits, MAPD |
| PLAN | OHP PREMIER (HMO) H9763-003-001 |
OHP PREMIER (HMO) H9763-003-002 |
OHP FREEDOM (HMO POS) H9763-002 |
|
|---|---|---|---|---|
| Plan Benefits | In-Network | In-Network | In-Network | Out-Of-Network |
| Premium | $0 | $0 | $0 | |
| PARISHES |
Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Lafourche, Livingston, Orleans, St. Charles, St John the Baptist, West Baton Rouge | St. Tammany | Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Lafourche, Livingston, Orleans, St. Charles, St John the Baptist, St. Tammany, West Baton Rouge | |
| Premium Part B Giveback | $30 | $17 | $0 | |
| Maximum Out of Pocket | $3,500 | $3,500 | $3,700 | N/A |
| Inpatient Hospital | $65 copay per day for days 1-10, $0 copay copayment for additional Medicare covered days | $65 copay per day for days 1-10, $0 copay copayment for additional Medicare covered days | $65 copay per day for days 1-7, $0 copay copayment for additional Medicare covered days | 20% |
| PCP Office Visits | $0 | $0 | $0 | 20% |
| Specialist Office Visits | $20 | $20 | $20 | 20% |
| Diagnostic tests | $10 | $10 | $10 | 20% |
| Outpatient x-rays | $20 | $20 | $35 | 20% |
| PLAN | OHP PREMIER (HMO) H9763-003-001 |
OHP PREMIER (HMO) H9763-003-002 |
OHP FREEDOM (HMO POS) H9763-002 |
|
|---|---|---|---|---|
| Plan Benefits | In-Network | In-Network | In-Network | Out-Of-Network |
| Premium | $0 | $0 | $0 | |
| PARISHES |
Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Lafourche, Livingston, Orleans, St. Charles, St John the Baptist, West Baton Rouge | St. Tammany | Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Lafourche, Livingston, Orleans, St. Charles, St John the Baptist, St. Tammany, West Baton Rouge | |
| Premium Part B Giveback | $30 | $17 | $0 | |
| Maximum Out of Pocket | $3,500 | $3,500 | $3,700 | N/A |
2023 Prescription Drug Benefits
| PLAN | OHP PREMIER (HMO) H9763-003-001 |
OHP PREMIER (HMO) H9763-003-002 |
OHP FREEDOM (HMO POS) H9763-002 |
|
|---|---|---|---|---|
| Plan Benefits | In-Network | In-Network | In-Network | Out-Of-Network |
| Rx Deductible | $0 | $0 | $0 | |
| Over-the-Counter items | $85 every calendar quarter | $85 every calendar quarter | $85 every calendar quarter | N/A |
| Rx Copay/Coinsurance | ||||
| Tier 1 Drugs | $0 copay | $0 copay | $0 copay | N/A |
| Tier 2 Drugs | $10 copay | $10 copay | $10 copay | N/A |
| Tier 3 Drugs | $45 copay | $45 copay | $45 copay | N/A |
| Select Insulin Drugs* | $35 copay | $35 copay | $35 copay | N/A |
| Tier 4 Drugs | $100 copay | $100 copay | $100 copay | N/A |
| Tier 5 Drugs | 33% coinsurance | 33% coinsurance | 33% coinsurance | N/A |
|
Mail Order/Retail 90 Day Copay |
||||
| Tier 1 Drugs | $0 copay | $0 copay | $0 copay | N/A |
| Tier 2 Drugs | $0 copay | $0 copay | $0 copay | N/A |
| Tier 3 Drugs | $135 copay | $135 copay | $135 copay | N/A |
| Select Insulin Drugs* | $105 copay | $105 copay | $105 copay | N/A |
| Tier 4 Drugs | $300 copay | $300 copay | $300 copay | N/A |
| Tier 5 Drugs | N/A | N/A | N/A | N/A |
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 are24 hours a day/365 days a year.
*Important Message About What You Pay for Select Insulin -You won’t pay more than $35 for a one-month supply of each Select Insulin product covered by our plan, no matter what cost-sharing tier it’s on.
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