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Liberty Medicare Dual Plan (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Liberty Medicare Dual Plan (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Liberty Medicare Dual Plan (HMO D-SNP) in 2025, please refer to our full plan details page.
Liberty Medicare Dual Plan (HMO D-SNP) is a HMO D-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 Dual Plan (HMO D-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 Dual Plan (HMO D-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 Dual Plan (HMO D-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 Dual Plan (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $24.30. 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 $7550.00 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 Dual Plan (HMO D-SNP) has a deductible of $590.00. If you qualify for the low-income subsidy, your monthly premium for Part D is $24.30. After your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. Once you reach $2000.00 in out-of-pocket drug costs, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Liberty Medicare Dual Plan (HMO D-SNP) offers a range of benefits, including no copay for preventive services, diagnostic and radiological services, and home health services, and routine eye exams. You will pay a 20% coinsurance for many services, such as outpatient services, ambulance services, primary care, hearing, dental, and medical equipment. The plan also covers prescription hearing aids up to $2,500 every three years, and eyewear up to $300 every two years.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered. Prior authorization is required.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a minimum and maximum coinsurance of 20%, and Individual and Group Sessions for Outpatient Substance Abuse with a minimum and maximum coinsurance of 20%. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Liberty Medicare Dual Plan (HMO D-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, with a 20% coinsurance for both ground and air ambulance services. Transportation Services to any health-related location are partially covered. Transportation Services to a plan-approved health-related location are covered for 20 one-way trips per year.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the Liberty Medicare Dual Plan (HMO D-SNP), with a 20% coinsurance. Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the Liberty Medicare Dual Plan (HMO D-SNP). Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance, while Chiropractic Services, Individual and Group Sessions for Mental Health Specialty Services, Routine Foot Care, Other Health Care Professional, Individual and Group Sessions for Psychiatric Services, have a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with 20% coinsurance, and additional services, although some services are not covered. Some additional preventive services are not covered, including Health Education, In-Home Safety Assessment, 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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids, all of which are covered. Prescription hearing aids are covered up to $2,500 every three years, while inner ear, outer ear, and over-the-ear prescription hearing aids, as well as OTC hearing aids, are not covered.
Vision Services See details
The Liberty Medicare Dual Plan (HMO D-SNP) covers vision services, including routine eye exams once per year with no copay, and eyewear with a combined maximum benefit of $300 every two years, along with contact lenses, eyeglass lenses, and eyeglass frames.
Dental Services See details
Dental Services are covered with a 20% coinsurance. Other Dental Services have a maximum plan benefit coverage of $2,500 per year, and include coverage for oral exams (2 per year), dental x-rays (1 per year), other diagnostic dental services, prophylaxis (cleaning) (2 every two years), fluoride treatment (2 per year), other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery. Adjunctive general services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered by the Liberty Medicare Dual Plan (HMO D-SNP), but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Liberty Medicare Dual Plan (HMO D-SNP), including Durable Medical Equipment (DME) with 20% coinsurance and Diabetic Supplies with 20% coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Therapeutic Shoes/Inserts are not covered. Prosthetic Devices and Medicare-covered Medical Supplies have a 20% coinsurance, and there is no copay for any of these services.
Diagnostic and Radiological Services See details
The Liberty Medicare Dual Plan (HMO D-SNP) covers diagnostic and radiological services, including diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. There is no copay for these services, but you may have to pay up to 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Liberty Medicare Dual Plan (HMO D-SNP) with no copay and no coinsurance, but prior authorization is required. 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 Dual Plan (HMO D-SNP). Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but require prior authorization. The plan charges the Medicare-defined cost share for tier 1, and the cost sharing is applied per admission or per stay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes a meal benefit for chronic illness, but acupuncture, over-the-counter items, 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. This plan does not require authorization or referrals for any additional services.
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