Liberty Medicare Dual Plan (HMO D-SNP)

North Carolina Medicare-Medicaid Dual Eligible D-SNP Plan (2024 Plan)


Monthly Premium

Your Cost
$47
by Liberty Medicare Advantage

Additional Coverage

HearingVisionDental

Overall Government Star Rating

No Rating (new plan)

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Plan Name
Liberty Medicare Dual Plan (HMO D-SNP)
Insurance Carrier
Liberty Medicare Advantage
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
HMO

Liberty Medicare Dual Plan (HMO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in North Carolina and offered by the health insurance company Liberty Medicare Advantage. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$47
Annual Deductible
$0 or $240 per year for in-network services.
Max Out-of-Pocket
$7,550
Primary doctor visit
0% or 20% coinsurance per visit
Specialist visit
0% or 20% coinsurance per visit
ER visit
0% or 20% coinsurance per visit (always covered)
Ambulance
0% or 20% coinsurance

Liberty Medicare Dual Plan (HMO D-SNP) has a monthly premium cost of $47 per month, with an annual deductible of $0 or $240 per year for in-network services. and a maximum out of pocket cost sharing of $7,550 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Liberty Medicare Dual Plan (HMO D-SNP) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Liberty Medicare Dual Plan (HMO D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Liberty Medicare Dual Plan (HMO D-SNP) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Liberty Medicare Dual Plan (HMO D-SNP) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Not covered
Over the counter drug benefits
Not covered
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Monthly Premium
$47
Health Portion of Premium
$0
Drug Portion of Premium
$47
Health Plan Deductible
$0 or $240 per year for in-network services.
Health Plan Max Out-of-Pocket
$7,550 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
0% or 20% coinsurance per visit
Specialist visit
0% or 20% coinsurance per visit

Tests, labs, & imaging

Diagnostic tests & procedures
0% or 20% coinsurance
Lab services
0% or 20% coinsurance
Diagnostic radiology services (like MRI)
0% or 20% coinsurance
Outpatient x-rays
0% or 20% coinsurance
Emergency care
0% or 20% coinsurance per visit (always covered)
Urgent care
0% or 20% coinsurance per visit (always covered)

Hospital Services

Inpatient hospital coverage
In 2024 the amounts for each benefit period are $0 or:
$1,632 deductible for days 1 through 60
$408 copay per day for days 61 through 90
Outpatient hospital coverage
0% or 20% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
In 2024 the amounts for each benefit period are $0 or:
$0 copay for days 1 through 20
$204 copay per day for days 21 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
0% or 20% coinsurance

Therapy services

Occupational therapy visit
0% or 20% coinsurance
Physical therapy & speech & language therapy visit
0% or 20% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist
0% or 20% coinsurance
Outpatient individual therapy with a psychiatrist
0% or 20% coinsurance
Outpatient group therapy visit
0% or 20% coinsurance
Outpatient individual therapy visit
0% or 20% coinsurance

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
0% or 20% coinsurance per item
Prosthetics (like braces, artificial limbs)
0% or 20% coinsurance per item
Diabetes supplies
0% or 20% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

Chemotherapy drugs
0% or 0-20% coinsurance
Other Part B drugs
0% or 0-20% coinsurance

Hearing

Hearing exam
$0 copay
Fitting/evaluation
$0 copay
Hearing aids - All types
$0 copay

Preventive Dental

Oral exam
$0 copay
Cleaning
$0 copay
Fluoride treatment
Not covered
Dental x-rays
$0 copay

Comprehensive dental

Non-routine services
$0 copay
Diagnostic services
$0 copay
Restorative services
$0 copay
Endodontics
$0 copay
Periodontics
$0 copay
Extractions
$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services
$0 copay

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
$0 copay

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