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Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) in 2025, please refer to our full plan details page.
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) is a HMO I-SNP plan offered by Liberty Healthcare Insurance available for enrollment in 2025 to people living in North Carolina (partial). This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP).
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 Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $51.00. 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6800.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, and you will pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) offers a range of benefits, including inpatient and outpatient services, with coinsurance costs ranging from 20%. Emergency and ambulance services are covered with no copay, and transportation to health-related locations is provided. This plan includes coverage for primary care, preventive services with no copay, hearing and vision services, and dental services with coinsurance. Additionally, it covers home infusion services, medical equipment, and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but additional days, non-Medicare covered stays, and upgrades for both are not covered. The plan requires prior authorization and has coinsurance for covered services.
Outpatient Services See details
Outpatient Services are covered by the Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP), including Outpatient Hospital Services and Observation Services, both with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are also covered, with a coinsurance between 20% and 20%. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP), but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP). Ground and air ambulance services have a 20% coinsurance, and there is no copay. Transportation services to a plan-approved health-related location are covered up to 55 one-way trips per year.
Emergency Services See details
Emergency Services are covered, with a 20% coinsurance, and no copay. Urgently Needed Services are also covered, with a 20% coinsurance and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Individual and Group Sessions for Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Individual and Group Sessions for Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered with a 20% coinsurance; however, Routine Chiropractic Care is not covered. Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Individual and Group Sessions for Mental Health Specialty Services, Other Health Care Professional, Individual and Group Sessions for Psychiatric Services, and Physical Therapy and Speech-Language Pathology Services require prior authorization. Routine Foot Care has a 20% coinsurance, and is limited to 12 visits per year. Additional Telehealth Benefits has no copay.
Preventive Services See details
Preventive services, including Medicare-covered services, annual physical exams, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs after a welcome visit, are covered with no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams once per year, and fitting/evaluation for hearing aids, both of which are unlimited. Prescription hearing aids are covered up to a maximum of $3450 every two years, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) covers vision services, including routine eye exams with a coinsurance of 0% - 20%, and eyewear with a combined maximum benefit of $450 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered under the Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP), with a 20% coinsurance for Medicare Dental Services; however, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP). Medicare Part B Insulin Drugs have a $35 copay, with a coinsurance between 0% and 20%, while other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP), but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment includes Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, both with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP). Diagnostic Procedures/Tests have no copay and a coinsurance of at most 20%, while Lab Services have a coinsurance of at most 20% with a minimum of 20%. Radiological Services, Diagnostic Radiological Services, Therapeutic Radiological Services and Outpatient X-Ray Services have no copay and a coinsurance of at most 20%, with a minimum coinsurance of 20% for Diagnostic, Therapeutic, and X-Ray Services.
Home Health Services See details
Home Health Services are covered by the Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP), with no copay or coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP). Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered and require prior authorization. This plan charges the Medicare-defined cost share for tier 1, and there is no cost sharing on the day of discharge. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items, with a maximum benefit coverage amount of $250.00 every three months, but acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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