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Ochsner Health Plan Freedom (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Ochsner Health Plan Freedom (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Ochsner Health Plan Freedom (HMO-POS) in 2025, please refer to our full plan details page.
Ochsner Health Plan Freedom (HMO-POS) is a HMO-POS plan offered by Ochsner Clinic Foundation available for enrollment in 2025 to people living in New Orleans and Baton Rouge Areas. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Ochsner Health Plan Freedom (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 Ochsner Health Plan Freedom (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 Ochsner Health Plan Freedom (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.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $8000.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8000.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $4100.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8000.00 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 Ochsner Health Plan Freedom (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and pharmacy. For example, you will pay a $10 copay for preferred generic drugs at a standard pharmacy. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Ochsner Health Plan Freedom (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays, and no copay for Ambulatory Surgical Center services. You'll also find coverage for emergency services and primary care, with copays for specialist visits and therapies. This plan includes preventive services, hearing and vision coverage, and dental services with a 25% coinsurance. Additional benefits include home health services with no copay, medical equipment with coinsurance, and coverage for diagnostic and radiological services.
Inpatient Hospital See details
Inpatient Hospital services are covered under the Ochsner Health Plan Freedom (HMO-POS) plan. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you'll pay a $175 copay for days 1-10, and no copay for days 11-90.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, Ambulatory Surgical Center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered by the Ochsner Health Plan Freedom (HMO-POS). Outpatient Hospital Services have a copay between $0 and $130, while Ambulatory Surgical Center (ASC) Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $20.
Partial Hospitalization See details
Partial hospitalization is covered by the Ochsner Health Plan Freedom (HMO-POS) plan, and requires prior authorization. You will pay a $40 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Ochsner Health Plan Freedom (HMO-POS) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $235 copay, while air ambulance services have a 20% coinsurance. 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 Ochsner Health Plan Freedom (HMO-POS) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Transportation has a 20% coinsurance and a $235 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have copays of $140 and $35, respectively.
Primary Care See details
The Ochsner Health Plan Freedom (HMO-POS) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $25 copay, mental health specialty services with a $25 copay, physical therapy and speech-language pathology services with a $20 copay, and additional telehealth benefits. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered services, annual physical exams, and additional services such as fitness benefits and kidney disease education services, though some additional preventive services are not covered. The plan covers glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. 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, 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 with the Ochsner Health Plan Freedom (HMO-POS) plan include hearing exams with a $20 copay, and prescription hearing aids (all types) with a limit of 2 visits per year. Prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a $20 copay, and coverage for eyewear with a combined maximum benefit of $400 per year, including contact lenses and eyeglasses. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Ochsner Health Plan Freedom (HMO-POS) plan covers Medicare dental services with no copay, while other dental services are covered for oral exams, dental x-rays, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, and oral and maxillofacial surgery with a 25% coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics, and orthodontics are not covered. Orthodontic services have a maximum benefit of $3000.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Ochsner Health Plan Freedom (HMO-POS). Medicare Part B Insulin Drugs have a $35 copay, 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 by the Ochsner Health Plan Freedom (HMO-POS) plan, 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 0% to 20% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment, including Diabetic Supplies with 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Ochsner Health Plan Freedom (HMO-POS). Diagnostic Procedures/Tests have a $10 copay, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $85, Therapeutic Radiological Services have a minimum copay of $80, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the Ochsner Health Plan Freedom (HMO-POS) with no copay or coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Ochsner Health Plan Freedom (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $178 copay for days 21-100, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Ochsner Health Plan Freedom (HMO-POS) plan does not cover acupuncture, 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, or Self-Directed Personal Assistance Services. Over-the-counter (OTC) items are covered with a maximum benefit of $110 every three months, and the plan offers a meal benefit for chronic illnesses that requires prior authorization and a doctor referral.
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