2023 New Hanover Health Advantage Freedom (HMO-POS)

New Hanover Health Advantage Freedom (HMO-POS) H6306-016 is a 2023 Medicare Advantage Plan or Part-C by FirstMedicare Direct available to residents in North Carolina. This plan does not provide extra prescription drug (Part-D) coverage. FirstMedicare Direct New Hanover Health Advantage Freedom (HMO-POS) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $4,500 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $4,500 out-of-pocket. This can be an extremely nice safety net.

FirstMedicare Direct works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for New Hanover Health Advantage Freedom (HMO-POS) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from FirstMedicare Direct and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from FirstMedicare Direct except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in North Carolina.



2023 FirstMedicare Direct Medicare Advantage Plan Overview

Name:New Hanover Health Advantage Freedom (HMO-POS)
Plan ID:H6306 016 0
Provider:FirstMedicare Direct
Year:2023
Type:Local HMO *
Combined Premium (C+D):$0/mo
MOOP:$4,500/yr
Similar Plan: H6306-005




What type of plan is New Hanover Health Advantage Freedom (HMO-POS)

New Hanover Health Advantage Freedom (HMO-POS) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your primary care physician will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.

With a HMO-POS point-of-service you have the option to go out-of-network or see a specialist without a referral. But, you may pay more for out-of-network care you receive than from an in-network provider.

How much does New Hanover Health Advantage Freedom (HMO-POS) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. FirstMedicare Direct charges a $0 premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. New Hanover Health Advantage Freedom (HMO-POS) by FirstMedicare Direct MOOP is $4,500. Once you spend $4,500 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.





2023 Summary of Benefits


The benefit information provided is a summary of what New Hanover Health Advantage Freedom (HMO-POS) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from FirstMedicare Direct helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)Covered



Contact lenses


Out-of-Network Vision$0 copay
In-Network Vision$0 copay



Eyeglass frames


Out-of-Network Vision$0 copay
In-Network Vision$0 copay



Eyeglass lenses


In-Network Vision$0 copay
Out-of-Network Vision$0 copay



Eyeglasses (frames and lenses)


In-Network Vision$0 copay
Out-of-Network Vision$0 copay



Other


VisionNot covered



Routine eye exam


In-Network Vision$0 copay



Upgrades


In-Network Vision$0 copay
Out-of-Network Vision$0 copay




In-Network Transportation$0 copay
In-Network Skilled Nursing Facility$0 per day for days 1 through 20
$196 per day for days 21 through 41
$0 per day for days 42 through 100
Out-of-Network Skilled Nursing Facility$0 per day for days 1 through 20
$196 per day for days 21 through 41
$0 per day for days 42 through 100



Occupational therapy visit


In-Network Rehabilitation services$35 copay
Out-of-Network Rehabilitation services$50 copay



Physical therapy and speech and language therapy visit


Out-of-Network Rehabilitation services$50 copay
In-Network Rehabilitation services$35 copay



Cleaning


Out-of-Network Preventive dental$0 copay
In-Network Preventive dental$0 copay



Dental x-ray(s)


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental$0 copay



Fluoride treatment


Preventive dentalNot covered



Oral exam


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental$0 copay




In-Network Preventive care$0 copay
Out-of-Network Preventive care$0 copay
In-Network Outpatient hospital coverage$300 copay per visit
Out-of-Network Outpatient hospital coverage$450 copay per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo



Inpatient hospital - psychiatric


Out-of-Network Mental health services$285 per day for days 1 through 10
$0 per day for days 11 through 90
In-Network Mental health services$160 per day for days 1 through 10
$0 per day for days 11 through 90



Outpatient group therapy visit


In-Network Mental health services$35 copay
Out-of-Network Mental health services$50 copay



Outpatient group therapy visit with a psychiatrist


In-Network Mental health services$35 copay
Out-of-Network Mental health services$50 copay



Outpatient individual therapy visit


Out-of-Network Mental health services$50 copay
In-Network Mental health services$35 copay



Outpatient individual therapy visit with a psychiatrist


Out-of-Network Mental health services$50 copay
In-Network Mental health services$35 copay



Chemotherapy


In-Network Medicare Part B drugs20% coinsurance
Out-of-Network Medicare Part B drugs20% coinsurance



Other Part B drugs


In-Network Medicare Part B drugs20% coinsurance
Out-of-Network Medicare Part B drugs20% coinsurance



Diabetes supplies


In-Network Medical equipment/supplies0-20% coinsurance per item
Out-of-Network Medical equipment/supplies20% coinsurance per item



Durable medical equipment (e.g., wheelchairs, oxygen)


In-Network Medical equipment/supplies20% coinsurance per item
Out-of-Network Medical equipment/supplies20% coinsurance per item



Prosthetics (e.g., braces, artificial limbs)


In-Network Medical equipment/supplies20% coinsurance per item
Out-of-Network Medical equipment/supplies20% coinsurance per item




Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$8,950 In and Out-of-network
$4,500 In-network
In-Network Inpatient hospital coverage$300 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-Network Inpatient hospital coverage$450 per day for days 1 through 6
$0 per day for days 7 through 90



Fitting/evaluation


In-Network Hearing$0 copay



Hearing aids


In-Network Hearing$0 copay



Hearing exam


Out-of-Network Hearing$50 copay
In-Network Hearing$35 copay




Health plan deductible$0
Out-of-Network Ground ambulance$265 copay
In-Network Ground ambulance$265 copay



Foot exams and treatment


Out-of-Network Foot care (podiatry services)$50 copay
In-Network Foot care (podiatry services)$35 copay



Routine foot care


Foot care (podiatry services)Not covered



Emergency


Emergency care/Urgent care$110 copay per visit (always covered)



Urgent care


Emergency care/Urgent care$35 copay per visit (always covered)



Primary


In-Network Doctor visits$0 copay
Out-of-Network Doctor visits$0 copay



Specialist


Out-of-Network Doctor visits$50 copay per visit
In-Network Doctor visits$35 copay per visit



Diagnostic radiology services (e.g., MRI)


In-Network Diagnostic procedures/lab services/imaging$0-275 copay
Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance



Diagnostic tests and procedures


Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance
In-Network Diagnostic procedures/lab services/imaging$0-85 copay



Lab services


In-Network Diagnostic procedures/lab services/imaging$0-50 copay
Out-of-Network Diagnostic procedures/lab services/imaging40% coinsurance



Outpatient x-rays


Out-of-Network Diagnostic procedures/lab services/imaging30% coinsurance
In-Network Diagnostic procedures/lab services/imaging$0-100 copay



Diagnostic services


Out-of-Network Comprehensive dental$0 copay
In-Network Comprehensive dental$0 copay



Endodontics


In-Network Comprehensive dental$0 copay
Out-of-Network Comprehensive dental$0 copay



Extractions


Out-of-Network Comprehensive dental$0 copay
In-Network Comprehensive dental$0 copay



Non-routine services


In-Network Comprehensive dental$0 copay
Out-of-Network Comprehensive dental$0 copay



Periodontics


In-Network Comprehensive dental$0 copay
Out-of-Network Comprehensive dental$0 copay



Prosthodontics, other oral/maxillofacial surgery, other services


Out-of-Network Comprehensive dental$0 copay
In-Network Comprehensive dental$0 copay



Restorative services


In-Network Comprehensive dental$0 copay
Out-of-Network Comprehensive dental$0 copay




In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No




New Hanover Health Advantage Freedom (HMO-POS) Reviews


Is New Hanover Health Advantage Freedom (HMO-POS) a good plan? New Hanover Health Advantage Freedom (HMO-POS) received a 4 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare New Hanover Health Advantage Freedom Reviews among several different plans.

2022 Overall Rating
Part C Summary Rating
Part-D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with H6306-016 Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for FirstMedicare Direct

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for New Hanover Health Advantage Freedom (HMO-POS) requires you to live in that plan’s service area. The service area is listed below:



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How much does New Hanover Health Advantage Freedom (HMO-POS) cost?

FirstMedicare Direct charges a $0 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is New Hanover Health Advantage Freedom (HMO-POS) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. New Hanover Health Advantage Freedom (HMO-POS) by FirstMedicare Direct MOOP is $4,500. Once you spend $4,500 you will pay nothing for Part A or Part B covered services.

What type of plan is New Hanover Health Advantage Freedom (HMO-POS)?

New Hanover Health Advantage Freedom (HMO-POS) is a Local HMO *. With a health maintenance organization you will be required to receive most of your health care from an in-network provider. HMOs require that you select a primary care physician (PCP).

With a HMO-POS point-of-service you have the option to go out-of-network or see a specialist without a referral. But, you may pay more for out-of-network care you receive than from an in-network provider.

Is New Hanover Health Advantage Freedom (HMO-POS) a good plan?

New Hanover Health Advantage Freedom (HMO-POS) received a 4 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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