Ochsner Health Plan Freedom (HMO POS)
- Out-of-network coverage:
Coordinated care and additional savings when using in-network providers - $85 credit per calendar quarter for over-the-counter health & wellness items from OTC Catalog
- 24-hour Nurse Hotline
- Medicare Part D prescription drug coverage
OHP Freedom (HMO POS) | In-network | Out-of-network |
---|---|---|
Monthly Plan Premium | $0 | $0 |
Part B Premium Give Back | This plan does not include a Part B Give Back. | |
Medicare Part D Prescription Drug Coverage | This plan includes Part D coverage. | |
Maximum out-of-pocket | $3,700 per year | |
Doctor Visits and Nurse Hotline | ||
Primary Care Physician Visit | $0 copay | 20% |
Specialist Visit | $20 copay | 20% |
24-Hour Nurse Line | $0 copay | $0 copay |
Preventive Care | ||
Pap Test, Pelvic Exams, Mammograms | $0 | 20% |
Prostate and Colorectal Cancer Screenings | $0 | 20% |
Vaccinations* | $0 | $0 |
Labs & Tests | ||
Lab Services (at contracted lab provider) | $0 | 20% |
Diagnostic Tests | $35 | 20% |
Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.) | $85 | 20% |
Outpatient Surgery |
||
Surgery at Outpatient Hospital or Ambulatory Surgery Center | $130 | 20% |
Inpatient Hospital Stay | ||
Inpatient Deductible | $0 | $0 |
Hospital Stay (days 1-7) | $65 per day | 20% |
Hospital Stay (days 8 and beyond) | $0 | 20% |
Emergency and Urgent Care |
|
|
Urgent Care | $20 copay | $20 copay |
Emergency Care | $90 copay | $90 copay |
Emergency & Urgent Care | If you are admitted to the hospital within one (1) day, the copay is waived. Covered Worldwide |
|
Additional Benefits Not Covered by Original Medicare |
|
|
Over-the-Counter Health & Wellness Items | $85 credit per calendar quarter from OTC Catalog | N/A |
Routine Vision Exam (1 per calendar year) | $0 copay for routine vision exam (through contracted provider) | N/A |
Glasses or Contact Lenses | Up to $200 allowance per calendar year (through contracted provider) | N/A |
Hearing Aids | Up to $1,000 per calendar year for both ears combined (through contracted provider) | N/A |
Dental Coverage - Preventive and Comprehensive | Up to $2,000 per calendar year, $50 comprehensive deductible applies before coverage begins (through contracted provider) | N/A |
Health Club Membership Ochsner Fitness Centers included: Downtown, Harahan, Heritage Plaza |
$0 copay (through contracted provider Silver&Fit) |
N/A |
Post Discharge Home Meal Delivery (inpatient hospital stay or skilled nursing facility stay) | $0 copay (through contracted provider) | N/A |
Additional Benefits – Part D Drug Coverage |
||
---|---|---|
Part D Deductible | $0 | |
Coverage through the Part D Coverage Gap | Tier 1 and Tier 2 | |
Drug Tier | 30-Day Supply Initial Coverage Stage |
90-Day Supply Initial Coverage Stage Retail & Mail Order |
Tier 1 (with coverage through the gap) | $0 | $0 |
Tier 2 (with coverage through the gap) | $10 | $0 |
Tier 3 | $45 | $135 |
Tier 4 | $100 | $300 |
Tier 5 | 33% coinsurance | 30-day supply only |
*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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