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New Hanover Health Advantage Platinum (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for New Hanover Health Advantage Platinum (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on New Hanover Health Advantage Platinum (HMO-POS) in 2025, please refer to our full plan details page.
New Hanover Health Advantage Platinum (HMO-POS) is a HMO-POS plan offered by The Carle Foundation available for enrollment in 2025 to people living in New Hanover, Pender, and Brunswick counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that New Hanover Health Advantage Platinum (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about New Hanover Health Advantage Platinum (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For New Hanover Health Advantage Platinum (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $53.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $7900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $7900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The New Hanover Health Advantage Platinum (HMO-POS) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay varying costs based on the drug tier and pharmacy. For example, you'll pay no copay for preferred generic drugs at a standard pharmacy, but you'll pay a $10 copay for the same drug through standard mail. After your total drug costs reach $2000, you will enter the catastrophic coverage phase.
Additional Benefits
The New Hanover Health Advantage Platinum (HMO-POS) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services have copays that vary by service. Emergency services and ambulance services have copays, and primary care visits have a $20-$25 copay. The plan covers preventive services, including hearing, vision, and dental, with copays and coinsurance applying to certain services. It also provides coverage for home health, skilled nursing, and other services such as acupuncture and over-the-counter items.
Inpatient Hospital See details
The New Hanover Health Advantage Platinum (HMO-POS) plan covers inpatient hospital services, including acute and psychiatric care. For Inpatient Hospital-Acute, you'll pay a $275 copay for days 1-6 and no copay for days 7-90. For Inpatient Hospital Psychiatric, you'll pay a $160 copay for days 1-10 and no copay for days 11-90.
Outpatient Services See details
The New Hanover Health Advantage Platinum (HMO-POS) plan covers outpatient hospital services and observation services with a $250 copay, and ambulatory surgical center services with a $175 copay. Outpatient substance abuse services, including individual and group sessions, have a copay between $25.00 and $25.00. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the New Hanover Health Advantage Platinum (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $40.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $265 copay for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 26 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the New Hanover Health Advantage Platinum (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a $265 copay; all services have no coinsurance.
Primary Care See details
The New Hanover Health Advantage Platinum (HMO-POS) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services, mental health specialty services with a $25 copay for individual and group sessions, psychiatric services with a $25 copay for individual and group sessions, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a $0-$25 copay, and opioid treatment program services with a $25 copay; however, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The New Hanover Health Advantage Platinum (HMO-POS) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, and additional preventive services. Some additional preventive services like Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, and others are not covered. The plan also covers Personal Emergency Response System (PERS), Remote Access Technologies, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. The plan also covers Fitness Benefit (Memory Fitness) up to $300 per year.
Hearing Services See details
Hearing services for the New Hanover Health Advantage Platinum (HMO-POS) plan include hearing exams and fitting/evaluation for hearing aids with no copay, while prescription hearing aids are covered up to $750 per ear every year. Prescription hearing aids (inner ear, outer ear, and over the ear) and OTC hearing aids are not covered.
Vision Services See details
The New Hanover Health Advantage Platinum (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $35, and eyewear with 20% coinsurance. Eyewear benefits include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Contact lenses and eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are unlimited. The plan offers a combined maximum benefit of $300 for all eyewear every year.
Dental Services See details
Dental services include a $35 copay for Medicare dental services, and other dental services have a 0% - 30% coinsurance; however, fluoride treatment and orthodontics are not covered. Restorative, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable, fixed), Maxillofacial Prosthetics, Implant Services, and Oral and Maxillofacial Surgery all have a $35 copay and 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while other drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the New Hanover Health Advantage Platinum (HMO-POS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment is covered by the New Hanover Health Advantage Platinum (HMO-POS) plan, with Durable Medical Equipment (DME) subject to a 20% coinsurance and requiring authorization. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The New Hanover Health Advantage Platinum (HMO-POS) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a copay between $0 and $85, lab services with no copay, and outpatient X-ray services with no copay. Diagnostic radiological services have a copay up to $275, and therapeutic radiological services have a coinsurance of at least 20% and a copay of at least $25.
Home Health Services See details
Home Health Services are covered by the New Hanover Health Advantage Platinum (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The copay information for Cardiac Rehabilitation Services is listed separately.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the New Hanover Health Advantage Platinum (HMO-POS) plan, but prior authorization is required. For days 1-20, there is no copay, for days 21-41 the copay is $214, and for days 42-100, there is no copay. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The New Hanover Health Advantage Platinum (HMO-POS) plan covers acupuncture with a limit of 15 treatments per year, and it also covers over-the-counter items up to $120 every three months. The plan also covers a meal benefit for chronic illness or medical conditions that require the enrollee to remain at home. However, the plan does not cover Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, or several other services.
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