Ochsner Health Plan HEROES (HMO POS) H9763-006
Baton Rouge and New Orleans Region
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.
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 in network |
| 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 | $20 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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