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Ochsner Health Plan Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Ochsner Health Plan Dual (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Ochsner Health Plan Dual (HMO D-SNP) in 2025, please refer to our full plan details page.
Ochsner Health Plan Dual (HMO D-SNP) is a HMO D-SNP plan offered by Ochsner Clinic Foundation available for enrollment in 2025 to people living in Greater New Orleans. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Ochsner Health Plan Dual (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:
Ochsner Health Plan Dual (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 Ochsner Health Plan Dual (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 Ochsner Health Plan Dual (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $55.60. 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 $9350.00 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 Ochsner Health Plan Dual (HMO D-SNP) has a $590 deductible for prescription drugs. After you meet your deductible, you'll pay for your drugs based on the tier and pharmacy you use, 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. If you qualify for the low-income subsidy, your monthly premium will be $55.60.
Additional Benefits
The Ochsner Health Plan Dual (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, including outpatient services, primary care, and preventive services, have a 20% coinsurance. Emergency services and ambulance services have a 20% coinsurance, with a $235 copay for worldwide emergency transportation. The plan also includes coverage for hearing and vision services, with a maximum of $2,000 per year for hearing exams and $400 for eyewear. Dental services are covered with a 20% coinsurance. Home infusion services and medical equipment have some cost-sharing. It also offers $252 per month for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered and require prior authorization. Additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and outpatient substance abuse services are covered with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services are covered with a 20% coinsurance as well.
Partial Hospitalization See details
Partial Hospitalization is covered by the Ochsner Health Plan Dual (HMO D-SNP) with prior authorization required. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance Services, including both ground and air ambulance services, are covered with no copay and 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 Dual (HMO D-SNP) plan. For Emergency Services and Urgently Needed Services, there is a 20% coinsurance, and for Worldwide Emergency Transportation, there is a 20% coinsurance and a $235 copay.
Primary Care See details
The Ochsner Health Plan Dual (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services with a 20% coinsurance. Routine Chiropractic Care has no copay, and Individual and Group Sessions for Mental Health and Psychiatric Services have a 20% coinsurance. Podiatry Services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered. Other services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have a 20% coinsurance. However, 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 services include hearing exams with a coinsurance of at most 20% and a maximum benefit of $2,000 per year, as well as fitting/evaluation for hearing aids, and prescription hearing aids (all types) limited to 2 visits per year; however, prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a 20% coinsurance, and eyewear. Eyewear includes 1 pair of contact lenses and 1 pair of eyeglasses (lenses and frames) per year, with a combined maximum of $400. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Ochsner Health Plan Dual (HMO D-SNP) plan covers dental services, with a 20% coinsurance for Medicare dental services. Other dental services include oral exams, dental x-rays, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery. Fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered, and some services have visit limits and require prior authorization. Orthodontic services have a maximum benefit of $3,500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin, Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. 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 Dual (HMO D-SNP) with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment is covered by the Ochsner Health Plan Dual (HMO D-SNP) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered; Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts all have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Ochsner Health Plan Dual (HMO D-SNP). All diagnostic services and radiological services have no copay, with a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Ochsner Health Plan Dual (HMO D-SNP) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Ochsner Health Plan Dual (HMO D-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) services are covered, but require prior authorization. The plan does not cover additional days beyond Medicare-covered for SNF, and does not cover non-Medicare-covered SNF stays. Cost sharing details, including copay information, are available.
Other Services See details
Other Services include Over-the-Counter (OTC) Items with a maximum benefit of $252.00 every month, and a meal benefit for a chronic illness that requires 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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