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Ochsner Health Plan Heroes (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Ochsner Health Plan Heroes (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 Heroes (HMO-POS) in 2025, please refer to our full plan details page.
Ochsner Health Plan Heroes (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 Heroes (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 Ochsner Health Plan Heroes (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 Heroes (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. Additionally, this plan comes with a Part B Premium reduction of $100.00. You must continue to pay paying your reduced 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 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 $4450.00 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
Prescription drugs are not covered by Ochsner Health Plan Heroes (HMO-POS).
Additional Benefits
The Ochsner Health Plan Heroes (HMO-POS) plan offers a range of benefits beyond standard Medicare, including coverage for inpatient and outpatient services, with varying copays. You'll have access to dental, vision, and hearing services, with copays for exams and coverage for eyewear and hearing aids. This plan also provides coverage for ambulance, emergency, and home health services, as well as medical equipment and diagnostic services, which all have copays or coinsurance. Additionally, the plan offers benefits such as an over-the-counter allowance and a meal benefit, but some services, such as certain dental procedures and home modifications, are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered under the Ochsner Health Plan Heroes (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; note that additional days for Inpatient Hospital Psychiatric, Non-Medicare-covered Stay for Inpatient Hospital-Acute, and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services with a copay between $0 and $175, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $20 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Ochsner Health Plan Heroes (HMO-POS) plan, but requires prior authorization. You will have a $40 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, 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 plan-approved and any health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, and Urgently Needed Services have a $35 copay, both with no coinsurance. 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 Heroes (HMO-POS) plan covers primary care 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, other health care professional services with a $25 copay, psychiatric services, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits, and opioid treatment program services; however, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services, including those not typically covered by Medicare, are covered by the Ochsner Health Plan Heroes (HMO-POS) plan. Additional preventive services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (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 Benefit, 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 (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with a $20 copay, with coverage for routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a $20 copay. Eyewear is covered up to a combined maximum of $300 per year, and contact lenses and eyeglasses (lenses and frames) are also covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered by Ochsner Health Plan Heroes (HMO-POS), including Medicare Dental Services with no copay, and other services like oral exams, dental x-rays, and cleaning. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, and oral and maxillofacial surgery are covered with a 25% coinsurance, while fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), 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. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Ochsner Health Plan Heroes (HMO-POS) plan, with a 20% coinsurance and prior authorization required.
Medical Equipment See details
Medical Equipment is covered under the Ochsner Health Plan Heroes (HMO-POS) plan, with Durable Medical Equipment (DME) costing a coinsurance between 0% and 20% and Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts costing a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a $10 copay, lab services with no copay, all radiological services, diagnostic radiological services with a copay up to $125, therapeutic radiological services with a copay of $50 or more, and outpatient X-ray services with a $50 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Ochsner Health Plan Heroes (HMO-POS) with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $178. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with a maximum benefit coverage amount of $85 every three months, and a meal benefit for chronic illnesses, with both requiring a doctor's referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
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