Compare 2019 Medicare Health Plans
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Medicare Plans
Florida - Southern
Charlotte County
Medicare Plans
Florida - Southern
Charlotte County
Sunday, December 15, 2019
Freedom Savings Plan Rx (HMO)
(H5427-053)
by Freedom Health Inc. - Charlotte County, FL
- The plan offers national in-network prescription coverage. This means that you will pay the same amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel).
Contact Information
Freedom Health Plan Inc.
5403 N. Church Ave.
Tampa, FL 33614
Phone: 1-800-401-2740
Toll free: 1-800-401-2740
Website
http://www.FreedomHealth.com
Pharmacy
http://www.freedomhealth.com
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Plan details
| Plan Rating | 3.5 out of 5 stars |
| Premium and Other Important Information | $0 monthly plan premium in addition to your monthly Medicare Part B premium. |
| Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay higher Part B and Part D premiums because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B and Part D premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. | |
| Freedom Health Inc. will reduce your monthly Medicare Part B premium by up to $ 40.00. | |
| $3 400 out-of-pocket limit for Medicare-covered services. | |
| Doctor and Hospital Choice | You must go to network doctors specialists and hospitals. |
| Referral required for network hospitals and specialists (for certain benefits). | |
| Inpatient Hospital Care | Plan covers 90 days each benefit period. |
| For Medicare-covered hospital stays: | |
| Days 1 - 8: $225 copay per day | |
| Days 9 - 90: $0 copay per day | |
| Plan covers 60 lifetime reserve days. $0 copay per lifetime reserve day. | |
| Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital. | |
| Inpatient Mental Health Care | You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital. |
| For Medicare-covered hospital stays: | |
| Days 1 - 8: $220 copay per day | |
| Days 9 - 90: $0 copay per day | |
| Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital. | |
| Skilled Nursing Facility (SNF) | Authorization rules may apply. |
| Plan covers up to 100 days each benefit period | |
| No prior hospital stay is required. | |
| For Medicare-covered SNF stays: | |
| Days 1 - 8: $0 copay per day | |
| Days 9 - 100: $95 copay per day | |
| Home Health Care | Authorization rules may apply. |
| $15 copay for each Medicare-covered home health visit | |
| Hospice | You must get care from a Medicare-certified hospice. Your plan will pay for a consultative visit before you select hospice. |
| Doctor Office Visits | Authorization rules may apply. |
| $0 copay for each primary care doctor visit for Medicare-covered benefits. | |
| $30 copay for each specialist visit for Medicare-covered benefits. | |
| Chiropractic Services | Authorization rules may apply. |
| $20 copay for each Medicare-covered visit | |
| Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers. | |
| Podiatry Services | Authorization rules may apply. |
| $30 copay for each Medicare-covered visit | |
| Medicare-covered podiatry benefits are for medically-necessary foot care. | |
| Outpatient Mental Health Care | Authorization rules may apply. |
| $30 copay for each Medicare-covered individual therapy visit | |
| $30 copay for each Medicare-covered group therapy visit | |
| $30 copay for each Medicare-covered individual therapy visit with a psychiatrist | |
| $30 copay for each Medicare-covered group therapy visit with a psychiatrist | |
| $225 copay for Medicare-covered partial hospitalization program services | |
| Outpatient Substance Abuse Care | Authorization rules may apply. |
| $30 to $200 copay for Medicare-covered individual visits | |
| $30 to $200 copay for Medicare-covered group visits | |
| Outpatient Services/Surgery | Authorization rules may apply. |
| $50 copay for each Medicare-covered ambulatory surgical center visit | |
| $200 copay for each Medicare-covered outpatient hospital facility visit | |
| Ambulance Services | Authorization rules may apply. |
| $100 copay for Medicare-covered ambulance benefits. | |
| Emergency Care | $50 copay for Medicare-covered emergency room visits |
| $25 000 plan coverage limit for emergency services outside the U.S. every year. | |
| Urgently Needed Care | $10 copay for Medicare-covered urgently-needed-care visits |
| Outpatient Rehabilitation Services | Authorization rules may apply. |
| There may be limits on physical therapy occupational therapy and speech and language pathology services If so there may be exceptions to these limits. | |
| $30 copay for Medicare-covered Occupational Therapy visits | |
| $30 copay for Medicare-covered Physical and/or Speech and Language Therapy visits | |
| Durable Medical Equipment | Authorization rules may apply. |
| 20% of the cost for Medicare-covered items | |
| Prosthetic Devices | Authorization rules may apply. |
| 20% of the cost for Medicare-covered items | |
| Diabetes Programs and Supplies | Authorization rules may apply. |
| $0 copay for Diabetes self-management training | |
| 0% to 20% of the cost for Diabetes monitoring supplies | |
| 20% of the cost for Therapeutic shoes or inserts | |
| If the doctor provides you services in addition to Diabetes self-management training separate cost sharing of $0 to $30 may apply | |
| Diagnostic Tests X-Rays Lab Services and Radiology Services | Authorization rules may apply. |
| $0 copay for Medicare-covered lab services | |
| $0 copay for Medicare-covered diagnostic procedures and tests | |
| $0 copay for Medicare-covered X-rays | |
| $25 to $100 copay for Medicare-covered diagnostic radiology services (not including X-rays) | |
| 20% of the cost for Medicare-covered therapeutic radiology services | |
| If the doctor provides you services in addition to Outpatient Diagnostic Procedures Tests and Lab Services separate cost sharing of $0 to $30 may apply | |
| If the doctor provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services separate cost sharing of $0 to $30 may apply | |
| Cardiac and Pulmonary Rehabilitation Services | Authorization rules may apply. |
| $30 to $200 copay for Medicare-covered Cardiac Rehabilitation Services | |
| $30 to $200 copay for Medicare-covered Intensive Cardiac Rehabilitation Services | |
| $30 to $200 copay for Medicare-covered Pulmonary Rehabilitation Services | |
| Preventive Services and Wellness/Education Programs | $0 copay for all preventive services covered under Original Medicare at zero cost sharing: |
| HIV screening is covered for people with Medicare who are pregnant and people at increased risk for the infection including anyone who asks for the test. Medicare covers this test once every 12 months or up to three times during a pregnancy. Please contact plan for details. | |
| The plan covers the following supplemental education/wellness programs: | |
| Kidney Disease and Conditions | Authorization rules may apply. |
| 20% of the cost for renal dialysis | |
| $0 copay for kidney disease education services | |
| Outpatient Prescription Drugs | 20% of the cost for Part B-covered chemotherapy drugs and other Part B-covered drugs. |
| This plan uses a formulary. The plan will send you the formulary. You can also see the formulary at www.freedomhealth.com on the web. | |
| Different out-of-pocket costs may apply for people who | |
| The plan offers national in-network prescription coverage (i.e. this would include 50 states and the District of Columbia). This means that you will pay the same cost-sharing amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel). | |
| Total yearly drug costs are the total drug costs paid by both you and a Part D plan. | |
| The plan may require you to first try one drug to treat your condition before it will cover another drug for that condition. | |
| Some drugs have quantity limits. | |
| Your provider must get prior authorization from Freedom Savings Plan Rx (HMO) for certain drugs. | |
| The plan will pay for certain over-the-counter drugs as part of its utilization management program. Some over-the-counter drugs are less expensive than prescription drugs and work just as well. Contact the plan for details. | |
| You must go to certain pharmacies for a very limited number of drugs due to special handling provider coordination or patient education requirements that cannot be met by most pharmacies in your network. These drugs are listed on the plan's website formulary printed materials as well as on the Medicare Prescription Drug Plan Finder on Medicare.gov. | |
| If the actual cost of a drug is less than the normal cost-sharing amount for that drug you will pay the actual cost not the higher cost-sharing amount. | |
| If you request a formulary exception for a drug and Freedom Savings Plan Rx (HMO) approves the exception you will pay Tier 3: Non-Preferred Brand Drugs cost sharing for that drug. | |
| $0 deductible. | |
| Supplemental drugs don't count toward your out-of-pocket drug costs. | |
| You pay the following until total yearly drug costs reach $2 930: | |
| Tier 1: Preferred Generic Drugs | |
| Tier 2: Preferred Brand Drugs | |
| Tier 3: Non-Preferred Brand Drugs | |
| Tier 4: Specialty Tier Drugs | |
| Tier 1: Preferred Generic Drugs | |
| Tier 2: Preferred Brand Drugs | |
| Tier 3: Non-Preferred Brand Drugs | |
| Tier 4: Specialty Tier Drugs | |
| Tier 1: Preferred Generic Drugs | |
| Tier 2: Preferred Brand Drugs | |
| Tier 3: Non-Preferred Brand Drugs | |
| Tier 4: Specialty Tier Drugs | |
| After your total yearly drug costs reach $2 930 you receive a discount on brand name drugs and pay 86% of the plan's costs for all generic drugs until your yearly out-of-pocket drug costs reach $4 700. | |
| After your yearly out-of-pocket drug costs reach $4 700 you pay the greater of: | |
| Plan drugs may be covered in special circumstances for instance illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Freedom Savings Plan Rx (HMO). | |
| You will be reimbursed up to the plan's cost of the drug minus the following for drugs purchased out-of-network until total yearly drug costs reach $2 930: | |
| Tier 1: Preferred Generic Drugs | |
| Tier 2: Preferred Brand Drugs | |
| Tier 3: Non-Preferred Brand Drugs | |
| Tier 4: Specialty Tier Drugs | |
| You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount. | |
| You will be reimbursed up to 14% of the plan allowable cost for generic drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4 700. You will be reimbursed up to the discounted price for brand name drugs purchased out-of-network until your total yearly out-of-pocket drug costs reach $4 700. | |
| You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount. | |
| After your yearly out-of-pocket drug costs reach $4 700 you will be reimbursed for drugs purchased out-of-network up to the plan's cost of the drug minus your cost share which is the greater of: | |
| You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount. | |
| Dental Services | $0 copay for Medicare-covered dental benefits |
| $0 copay for an office visit that includes: | |
| Hearing Services | |
| $500 plan coverage limit for hearing aids every two years. | |
| Vision Services | |
| $100 plan coverage limit for eye wear every year. | |
| Plan offers additional vision benefits. Contact plan for details. | |
| Over-the-Counter Items | Please visit our plan website to see our list of covered Over-the-Counter items. OTC items may be purchased only for the enrollee. Please contact the plan for specific instructions for using this benefit. |
| Transportation | $0 copay for up to 4 one-way trip(s) to plan-approved location every year |
| Acupuncture | This plan does not cover Acupuncture. |
| Premium and Other Important Information | In 2012 the monthly Part B Standard Premium is $99.90 and the annual Part B deductible amount is $140. |
| If a doctor or supplier does not accept assignment their costs are often higher which means you pay more. | |
| Most people will pay the standard monthly Part B premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. | |
| Doctor and Hospital Choice | You may go to any doctor specialist or hospital that accepts Medicare. |
| Inpatient Hospital Care | In 2012 the amounts for each benefit period are: Days 1 - 60: $1 156 deductible Days 61 - 90: $289 per day Days 91 - 150: $578 per lifetime reserve day |
| Call 1-800-MEDICARE (1-800-633-4227) for information about lifetime reserve days. | |
| Lifetime reserve days can only be used once. | |
| "A ""benefit period"" starts the day you go into a hospital or skilled nursing facility. It ends when you go for 60 days in a row without hospital or skilled nursing care. If you go into the hospital after one benefit period has ended a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have." | |
| Inpatient Mental Health Care | In 2012 the amounts for each benefit period are: Days 1 - 60: $1 156 deductible Days 61 - 90: $289 per day Days 91 - 150: $578 per lifetime reserve day |
| You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital. | |
| Skilled Nursing Facility (SNF) | In 2012 the amounts for each benefit period after at least a 3-day covered hospital stay are: Days 1 - 20: $0 per day Days 21 - 100: $144.50 per day |
| 100 days for each benefit period. | |
| "A ""benefit period"" starts the day you go into a hospital or SNF. It ends when you go for 60 days in a row without hospital or skilled nursing care. If you go into the hospital after one benefit period has ended a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have." | |
| Home Health Care | $0 copay. |
| Hospice | You pay part of the cost for outpatient drugs and inpatient respite care. |
| You must get care from a Medicare-certified hospice. | |
| Doctor Office Visits | 20% coinsurance |
| Chiropractic Services | Supplemental routine care not covered |
| 20% coinsurance for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers. | |
| Podiatry Services | Supplemental routine care not covered. |
| 20% coinsurance for medically necessary foot care including care for medical conditions affecting the lower limbs. | |
| Outpatient Mental Health Care | 40% coinsurance for most outpatient mental health services |
| Specified copayment for outpatient partial hospitalization program services furnished by a hospital or community mental health center (CMHC). Copay cannot exceed the Part A inpatient hospital deductible. | |
| """Partial hospitalization program"" is a structured program of active outpatient psychiatric treatment that is more intense than the care received in your doctor's or therapist's office and is an alternative to inpatient hospitalization." | |
| Outpatient Substance Abuse Care | 20% coinsurance |
| Outpatient Services/Surgery | 20% coinsurance for the doctor's services |
| Specified copayment for outpatient hospital facility services Copay cannot exceed the Part A inpatient hospital deductible. | |
| 20% coinsurance for ambulatory surgical center facility services | |
| Ambulance Services | 20% coinsurance |
| Emergency Care | 20% coinsurance for the doctor's services |
| Specified copayment for outpatient hospital facility emergency services. | |
| Emergency services copay cannot exceed Part A inpatient hospital deductible for each service provided by the hospital. | |
| You don't have to pay the emergency room copay if you are admitted to the hospital as an inpatient for the same condition within 3 days of the emergency room visit. | |
| Not covered outside the U.S. except under limited circumstances. | |
| Urgently Needed Care | 20% coinsurance or a set copay |
| NOT covered outside the U.S. except under limited circumstances. | |
| Outpatient Rehabilitation Services | 20% coinsurance |
| Durable Medical Equipment | 20% coinsurance |
| Prosthetic Devices | 20% coinsurance |
| Diabetes Programs and Supplies | 20% coinsurance for diabetes self-management training |
| 20% coinsurance for diabetes supplies | |
| 20% coinsurance for diabetic therapeutic shoes or inserts | |
| Diagnostic Tests X-Rays Lab Services and Radiology Services | 20% coinsurance for diagnostic tests and x-rays |
| $0 copay for Medicare-covered lab services | |
| Lab Services: Medicare covers medically necessary diagnostic lab services that are ordered by your treating doctor when they are provided by a Clinical Laboratory Improvement Amendments (CLIA) certified laboratory that participates in Medicare. Diagnostic lab services are done to help your doctor diagnose or rule out a suspected illness or condition. Medicare does not cover most supplemental routine screening tests like checking your cholesterol. | |
| Cardiac and Pulmonary Rehabilitation Services | 20% coinsurance Cardiac Rehabilitation services 20% coinsurance for Pulmonary Rehabilitation services 20% coinsurance for Intensive Cardiac Rehabilitation services |
| This applies to program services provided in a doctor+s office. Specified cost sharing for program services provided by hospital outpatient departments. | |
| Preventive Services and Wellness/Education Programs | No coinsurance copayment or deductible for the following: |
| Kidney Disease and Conditions | 20% coinsurance for renal dialysis |
| 20% coinsurance for kidney disease education services | |
| Outpatient Prescription Drugs | Most drugs are not covered under Original Medicare. You can add prescription drug coverage to Original Medicare by joining a Medicare Prescription Drug Plan or you can get all your Medicare coverage including prescription drug coverage by joining a Medicare Advantage Plan or a Medicare Cost Plan that offers prescription drug coverage. |
| Dental Services | Preventive dental services (such as cleaning) not covered. |
| Hearing Services | Supplemental routine hearing exams and hearing aids not covered. |
| 20% coinsurance for diagnostic hearing exams. | |
| Vision Services | 20% coinsurance for diagnosis and treatment of diseases and conditions of the eye. |
| Supplemental routine eye exams and glasses not covered. | |
| Medicare pays for one pair of eyeglasses or contact lenses after cataract surgery. | |
| Annual glaucoma screenings covered for people at risk. | |
| Over-the-Counter Items | Not covered. |
| Transportation | Not covered. |
| Acupuncture | Not covered. |
| Point of Service | You may go to any doctor specialist or hospital that accepts Medicare. |
Medicare Terms
- • Co-payment
- An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor's visit, hospital outpatient visit, or a prescription. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor's visit or prescription.
- • Cost Plans
- A type of Medicare health plan available in some areas. In a Medicare Cost Plan, if you get services outside of the plan's network without a referral, your Medicare-covered services will be paid for under Original Medicare (your Cost Plan pays for emergency services, or urgently needed services).
- • Deductible
- The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.
- • HMO - Health Maintenance Organization
- Local HMOs are plans with defined networks of providers, which beneficiaries must use in order to receive coverage, serving specific geographic areas consisting of aggregations of counties.
- • HMO SNP - Special Needs Plan
- Medicare Special Needs Plans are a type of Medicare Advantage Plan (Part C) for people with certain chronic diseases and conditions or who have specialized needs (such as people who have both Medicare and Medicaid or people who live in certain institutions). Medicare SNPs provide their members with all Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance) services, and Medicare prescription drug coverage (Part D). Medicare SNPs were created to give certain groups of people better access to Medicare with plans designed to meet their unique needs.
- • HMO with POS Option
- An HMO POS is a Medicare Advantage Plan that is a Health Maintenance Organization with a more flexible network allowing Plan Members to seek care outside of the traditional HMO network under certain situations or for certain treatment.
- • LPPO - Local Preferred Provider Organization
- Local PPOs are network based plans that serve specific geographic areas consisting of aggregations of counties, like HMOs, but with more flexibility in provider choice within the network. Beneficiaries may use providers outside the network but will pay more out of pocket cost.
Related Links
- Medicare.gov
The official U.S. Government site for Medicare - AARP
American Association of Retired Persons - HHS.gov
United States Department of Health & Human Services - CMS.gov
Centers for Medicare & Medicaid Services - Social Security Administration
The official website of the U.S. Social Security Administration
Help is available. If you have limited income and resources, you may qualify for help paying your Medicare health care and/or prescription drug coverage costs. For more information, visit socialsecurity.gov, call Social Security at 1-800-772-1213, or apply for help at your State Medical Assistance (Medicaid) office.
If you have questions about Medicare, visit medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
