Ochsner Health Plan HEROES (HMO POS) H9763-006

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Baton Rouge and New Orleans Region

$0 PLAN PREMIUM

per month

Available in these parishes:
Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Lafourche, Livingston. Orleans, St. Charles, St. John, West Baton Rouge

This plan does NOT include Part D drug coverage.

Get more than Original Medicare with these great benefits.

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$85 OTC PER QUARTER

Flex Card for over-the-counter items.

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$60 PART B GIVE BACK

That's $720 per year back to you!

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$3,000 DENTAL

per year with no deductible.

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$1,000 HEARING

coverage per year.

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$350 VISION

Exams, glasses & contacts.

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FITNESS INCLUDED

$0 SilverSneakers Membership

Plan Benefits

Ochsner Health Plan Heroes (HMO POS) H9763-006
Baton Rouge / New Orleans Region
Your Cost
Monthly Plan Premium $0
Part B Premium Give Back Up to $60 per month
Medicare Part D Prescription Drug Coverage This plan does not include Part D coverage
Maximum Out of Pocket $4,900 per year
Doctor Visits
Primary Care Physician Visit $0
Specialist Visit $30 copay Out-of-network 30% 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 30% coinsurance per visit
Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.) $125 copay Out-of-network 30% coinsurance per visit
Therapeutic Radiology and Outpatient X-Rays $50 copay Out-of-network 30% 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 $30 copay
Emergency Care $90 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 $175 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). Out of network 30% coinsurance.
Glasses or Contact Lenses Up to $350 allowance per calendar year (through contracted provider).
Hearing aids, Routine hearing exams, Hearing aid fitting/evaluations Routine hearing exams $20 copay. Out of network 30% coinsurance. Up to $1,000 combined maximum allowance per calendar year (through contracted provider). No out-of-network coverage for routine eye exams and routine eyewear.
Dental Coverage - Preventive and Comprehensive $0 copay per Medicare-covered visit. Up to $3,000 combined maximum allowance per calendar year for preventive and comprehensive dental services (through contracted provider).
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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