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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 $4500.00 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 an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a copay for some drugs, depending on the tier and pharmacy. For example, standard generic drugs have a $45 copay, while preferred brand drugs have a $100 copay. After your yearly out-of-pocket drug costs reach $2,000, you will enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Ochsner Health Plan Freedom (HMO-POS) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with copays varying by service. Emergency services have a $125 copay, and primary care services have a $20-$30 copay depending on the service. The plan also includes coverage for hearing, vision, and dental services, with specific copays and limitations. This plan provides coverage for a variety of services, such as ambulance, home health, skilled nursing, and dialysis services. Additionally, the plan covers diagnostic and radiological services, as well as medical equipment, with varying copays and coinsurance amounts. The plan also has an OTC benefit, covering up to $90 every three months, and offers meal benefits with prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, there is a $190 copay for days 1-10, and no copay for days 11-90; additional days are covered with no copay. Inpatient Hospital Psychiatric has a $190 copay for days 1-10, and no copay for days 11-90. However, additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered, and non-Medicare covered stays and upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $175, while individual and group substance abuse sessions have a $25 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Ochsner Health Plan Freedom (HMO-POS) with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Ochsner Health Plan Freedom (HMO-POS) plan. 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 are covered, with a $125 copay. Urgently needed services are covered with a $35 copay. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are also covered; Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has a $35 copay, and Worldwide Emergency Transportation has a $235 copay and 20% coinsurance.
Primary Care See details
The Ochsner Health Plan Freedom (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, physician specialist services have a $30 copay, and physical therapy and speech-language pathology services have a $20 copay. Individual and group sessions for mental health and psychiatric services have a $25 copay. Routine Chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services with no copay, as well as annual physical exams, and additional preventive services. The plan does not cover health education, in-home safety assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), 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. This plan also covers kidney disease education services (prior authorization required), glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following welcome visits.
Hearing Services See details
Hearing services with the Ochsner Health Plan Freedom (HMO-POS) include hearing exams with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids (all types) are covered for two visits per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Ochsner Health Plan Freedom (HMO-POS) plan covers vision services, including eye exams with a $20 copay and eyewear. Eyewear has a combined maximum plan benefit coverage of $400 per year, while eyeglass lenses, eyeglass frames and upgrades are not covered.
Dental Services See details
Dental services include Medicare dental services with no copay, and other dental services. Other dental services include oral exams, dental x-rays, and prophylaxis (cleaning), with prior authorization, and are subject to limitations. Other services include restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, and oral and maxillofacial surgery, each with 25% coinsurance, and are subject to limitations. Fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered. Orthodontic services are covered, with a maximum benefit of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Ochsner Health Plan Freedom (HMO-POS) plan, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Ochsner Health Plan Freedom (HMO-POS) plan, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 0-20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a 20% coinsurance for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Ochsner Health Plan Freedom (HMO-POS) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a $10 copay, and lab services with no copay. Diagnostic radiological services have a maximum copay of $125, therapeutic radiological services have a maximum copay of $80, and outpatient X-ray services have a $30 copay.
Home Health Services See details
Home Health Services are covered by the Ochsner Health Plan Freedom (HMO-POS) with no copay and no coinsurance, but authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered. Prior authorization is required for this benefit.
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; 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 covers Over-the-Counter (OTC) items with a maximum benefit of $90 every three months, and covers meal benefits with prior authorization and a doctor referral. 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, and Self-Directed Personal Assistance Services are not covered.
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