Liberty Medicare Dual Plan (HMO D-SNP)
North Carolina Medicare-Medicaid Dual Eligible D-SNP Plan (2026 Plan)
by Liberty Medicare Advantage
Additional Coverage
HearingVisionDental
Overall Government Star Rating
(coming soon)
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)
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.
Annual Deductible
Coming soon
Primary doctor visit
20% coinsurance
Specialist visit
20% coinsurance
Ambulance
20% coinsurance
Liberty Medicare Dual Plan (HMO D-SNP) has a monthly premium cost of $15 per month, with an annual deductible of Coming soon 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
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
Over the counter drug benefits
Home and bathroom safety devices
Health Portion of Premium
Health Plan Max Out-of-Pocket
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Specialist visit
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Lab services
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Diagnostic radiology services (like MRI)
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient x-rays
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Hospital Services
Inpatient hospital coverage
Tier 1
$0 per day for days 1-60
$419 per day for days 61-90
$838 per day for days 91-150
Outpatient hospital coverage
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Skilled nursing facility
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Therapy services
Occupational therapy visit
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Physical therapy & speech & language therapy visit
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Mental health services
Outpatient group therapy with a psychiatrist
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient group therapy visit
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy visit
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Diabetes supplies
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Catastrophic coverage phase |
|---|
| Preferred Generic |
Generic drugs :
25% coinsurance Brand-name drugs :
25% coinsurance |
Generic drugs :
0% coinsurance Brand-name drugs :
0% coinsurance |
| Generic |
| Preferred Brand |
| Non-Preferred Drug |
| Specialty Tier |
Part B Drugs
Chemotherapy drugs
In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance
Other Part B drugs
In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance
Hearing
Hearing exam
In-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - prescription
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - over the counter
Preventive Dental
Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: $0 copay
Maxillofacial prosthetics
In-network: $0 copay
Out-of-network: $0 copay
Implant services
In-network: $0 copay
Out-of-network: $0 copay
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Adjunctive general services
Vision
Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: $0 copay
Upgrades
In-network: $0 copay
Out-of-network: $0 copay
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