Ochsner Health Plan Premier (HMO)

  • Up to $30/month Part B premium give back H9763-003-001
  • Up to $17/month Part B premium give back H9763-003-002 St. Tammany
    We pay part of your Medicare Part B premium, putting money back in your pocket 
  • $85 credit per calendar quarter for over-the-counter health & wellness items from OTC Catalog
  • Medicare Part D included 
  • $0 copay primary care doctor visits
  • 24-hour Nurse Hotline (Ochsner On Call)
  • Maximum out of pocket, $3,500/year
Monthly Plan Premium $0
Part B Premium Give Back Up to $30 per month
Up to $17 per month – St Tammany Parish
Medicare Part D Prescription Drug Coverage This plan includes Part D coverage
Maximum Out of Pocket $3,500 per year
Doctor Visits and Nurse Hotline
Primary Care Physician Visit $0 copay
Specialist Visit $20 copay
24-Hour Nurse Line $0 copay
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
Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.) $20
Outpatient Surgery
Surgery at Outpatient Hospital or Ambulatory Surgery Center $125
Inpatient Hospital Stay
Inpatient Deductible $0
Hospital Stay (days 1-10) $65 per day
Hospital Stay (days 11 and beyond) $0

  Emergency and Urgent Care

Urgent Care $20
Emergency Care $90
Emergency & Urgent Care If you are admitted to the hospital within one (1) day, the copay is waived. Covered Worldwide

Inpatient Hospital Stay

Emergency Ambulance Service (per one day trip, ground or air) $235 ground
20% air

  Additional Benefits Not Covered by Original Medicare

Over-the-Counter Health & Wellness Items $85 credit per calendar quarter from OTC Catalog
Routine Vision Exam (1 per calendar year) $0 copay for routine vision exam (through contracted provider)
Glasses or Contact Lenses Up to $200 allowance per calendar year (through contracted provider)
Hearing Aids Up to $1,000 allowance per calendar year for both ears combined (through contracted provider)
Dental Coverage - Preventive and Comprehensive Up to $2,000 allowance per calendar year, $50 comprehensive deductible applies before coverage begins (through contracted provider)
Health Club Membership (Silver & Fit)
Ochsner Fitness Centers included: Downtown, Harahan, Heritage Plaza
$0 Copay (through contracted provider Silver&Fit)
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 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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