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FirstMedicare Direct POS Choice (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for FirstMedicare Direct POS Choice (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on FirstMedicare Direct POS Choice (HMO-POS) in 2025, please refer to our full plan details page.
FirstMedicare Direct POS Choice (HMO-POS) is a HMO-POS plan offered by The Carle Foundation available for enrollment in 2025 to people living in Sandhills and Wake Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that FirstMedicare Direct POS Choice (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about FirstMedicare Direct POS Choice (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 FirstMedicare Direct POS Choice (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8950.00 (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 $8950.00 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
Prescription drugs are not covered by FirstMedicare Direct POS Choice (HMO-POS).
Additional Benefits
The FirstMedicare Direct POS Choice (HMO-POS) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the specific service. Emergency, primary care, preventive, hearing, vision, and dental services are also covered. You will likely pay copays for services like inpatient hospital stays, specialist visits, and dental services, but many preventive services have no copay. This plan also includes coverage for home health, medical equipment, and diagnostic services. Additionally, the plan provides coverage for ambulance, emergency, and worldwide emergency services, with specific copays. Other benefits include coverage for acupuncture, over-the-counter items, and a meal benefit for certain medical conditions.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-10, and no copay for days 11-90. For Inpatient Hospital Psychiatric, you will pay a $160 copay for days 1-10, and no copay for days 11-60. Additional days and non-Medicare-covered stays are covered for Inpatient Hospital-Acute, but upgrades and additional days, and non-Medicare-covered stays are not covered for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $250, observation services, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered, including individual and group sessions with a copay of $30. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the FirstMedicare Direct POS Choice (HMO-POS) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance for all ambulance services. Ground Ambulance Services have a $350 copay, and Air Ambulance Services have a $450 copay, 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 FirstMedicare Direct POS Choice (HMO-POS) plan. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a $10 copay and no coinsurance, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage, a $10 copay for Worldwide Urgent Coverage, and a $350-$450 copay for Worldwide Emergency Transportation, with a maximum plan benefit of $10,000.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits and Opioid Treatment Program Services are covered. Chiropractic Services are covered with a $20 copay, and routine chiropractic care is not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams, and additional preventive services. Fitness benefits are covered up to $360 per year, and remote access technologies are covered. However, health education, in-home safety assessments, and several other services are not covered.
Hearing Services See details
Hearing services are covered, including routine hearing exams with a $30 copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $495 and $1695, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The FirstMedicare Direct POS Choice (HMO-POS) plan covers vision services, including routine eye exams with one visit per year. Eyewear, including contact lenses, eyeglasses, lenses, and frames, are covered with a 20% coinsurance for contact lenses and a combined maximum benefit of $200 per year.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $35 copay, and Other Dental Services with a $50 deductible, up to a maximum of $2,000 per year. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered. Restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery have a 30% coinsurance, while prosthodontics (removable), maxillofacial prosthetics, implant services, and prosthodontics (fixed) have a 50% coinsurance; fluoride treatment and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the FirstMedicare Direct POS Choice (HMO-POS) plan. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the FirstMedicare Direct POS Choice (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, with Durable Medical Equipment (DME) subject to a coinsurance between 0% and 20% and requiring authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no copay, and a 20% coinsurance applies to both, while Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the FirstMedicare Direct POS Choice (HMO-POS) plan. Diagnostic services have no copay, while Diagnostic Radiological Services have a maximum copay of $275, and Therapeutic Radiological Services have a maximum copay of $60; however, Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the FirstMedicare Direct POS Choice (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 technically covered, but none of the specific services (Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services) are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the FirstMedicare Direct POS Choice (HMO-POS) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under the FirstMedicare Direct POS Choice (HMO-POS) plan, acupuncture has a $30 copay and is limited to 15 treatments per year. The plan also covers over-the-counter (OTC) items up to $35 every three months, and offers a meal benefit for chronic or home-bound medical conditions. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
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