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2013 Medicare Advantage Plan Benefit Details for the Freedom Savings Plan (HMO)
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2013 Medicare Advantage Plan Details
Medicare Plan Name:Freedom Savings Plan (HMO)
Location:Miami-Dade, Florida 33142     Click to see other locations
Plan ID:H5427 - 052 - 0     Click to see other plans
Member Services:1-800-401-2740 TTY users 1-800-955-8771
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
Medicare Contact Information:Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.
TTY users 1-877-486-2048
or contact your local SHIP for assistance
Email a copy of the Freedom Savings Plan (HMO) benefit details
— Medicare Plan Features —
Monthly Premium:$0.00 (see Plan Premium Details below)
Annual Deductible:no drug coverage
Health Plan Type:Local HMO *
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$3,400
Number of Members enrolled in this plan in (H5427 - 052):2,323 members
Plan’s Summary Star Rating: 3.5 out of 5 Stars.
• Customer Service Rating: 4 out of 5 Stars.
• Member Experience Rating: 4 out of 5 Stars.
• Drug Cost Accuracy Rating: 4 out of 5 Stars.
— Plan Premium Details —
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔100%
Subsidy		75%
Subsidy		50%
Subsidy		25%
Subsidy
Monthly Part D Premium with LIS:$0.00$0.00$0.00$0.00
— Plan Health Benefits —
** Cost **
Premium and Other Important Information
$0.00 monthly plan premium in addition to your monthly Medicare Part B premium.
Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
Freedom Health Inc. will reduce your monthly Medicare Part B premium by up to $ 99.90.
$3 400 out-of-pocket limit for Medicare-covered services.
** Doctor and Hospital Choice **
Doctor and Hospital Choice
You must go to network doctors specialists and hospitals.
Referral required for network hospitals and specialists (for certain benefits).
** Extra Benefits **
Over-the-Counter Items
The plan does not cover Over-the-Counter items.
Transportation
$0 copay for up to 4 one-way trip(s) to plan-approved location every year
** Important Information **
Premium and Other Important Information
$0.00 monthly plan premium in addition to your monthly Medicare Part B premium.
Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
Freedom Health Inc. will reduce your monthly Medicare Part B premium by up to $ 99.90.
$3 400 out-of-pocket limit for Medicare-covered services.
Doctor and Hospital Choice
You must go to network doctors specialists and hospitals.
Referral required for network hospitals and specialists (for certain benefits).
** Inpatient Care **
Inpatient Hospital Care
Plan covers 90 days each benefit period.
For Medicare-covered hospital stays:
  • Days 1 - 6: $335 copay per day
  • Days 7 - 90: $0 copay per day
    • Plan covers 60 lifetime reserve days. $0 copay per lifetime reserve day.
    Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.
    Inpatient Mental Health Care
    You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital.
    For Medicare-covered hospital stays:
    • Days 1 - 6: $250 copay per day
  • Days 7 - 90: $0 copay per day
    • Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.
    Skilled Nursing Facility (SNF)
    Authorization rules may apply.
    Plan covers up to 100 days each benefit period
    No prior hospital stay is required.
    For Medicare-covered SNF stays:
    • Days 1 - 8: $0 copay per day
  • Days 9 - 100: $95 copay per day
    • Home Health Care
    Authorization rules may apply.
    $15 copay for each Medicare-covered home health visit
    Hospice
    You must get care from a Medicare-certified hospice. Your plan will pay for a consultative visit before you select hospice.
    ** Outpatient Care **
    Doctor Office Visits
    Authorization rules may apply.
    $0 copay for each Medicare-covered primary care doctor visit.
    $45 copay for each Medicare-covered specialist visit.
    Chiropractic Services
    Authorization rules may apply.
    $20 copay for each Medicare-covered chiropractic visit
    Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor.
    Podiatry Services
    Authorization rules may apply.
    $45 copay for each Medicare-covered podiatry visit
    Medicare-covered podiatry visits are for medically-necessary foot care.
    Outpatient Mental Health Care
    Authorization rules may apply.
    $40 copay for each Medicare-covered individual therapy visit
    $40 copay for each Medicare-covered group therapy visit
    $40 copay for each Medicare-covered individual therapy visit with a psychiatrist
    $40 copay for each Medicare-covered group therapy visit with a psychiatrist
    $110 copay for Medicare-covered partial hospitalization program services
    Outpatient Substance Abuse Care
    Authorization rules may apply.
    $45 to $250 copay for Medicare-covered individual substance abuse outpatient treatment visits
    $45 to $250 copay for Medicare-covered group substance abuse outpatient treatment visits
    Outpatient Services
    Authorization rules may apply.
    $50 copay for each Medicare-covered ambulatory surgical center visit
    $250 copay for each Medicare-covered outpatient hospital facility visit
    Ambulance Services
    Authorization rules may apply.
    $100 copay for Medicare-covered ambulance benefits.
    Emergency Care
    $50 copay for Medicare-covered emergency room visits
    $25 000 plan coverage limit for supplemental emergency services outside the U.S. and its territories every year.
    Urgently Needed Care
    $10 copay for Medicare-covered urgently-needed-care visits
    Outpatient Rehabilitation Services
    Authorization rules may apply.
    There may be limits on physical therapy occupational therapy and speech and language pathology visits. If so there may be exceptions to these limits.
    $45 copay for Medicare-covered Occupational Therapy visits
    $45 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    Authorization rules may apply.
    20% of the cost for Medicare-covered durable medical equipment
    Prosthetic Devices
    Authorization rules may apply.
    20% of the cost for Medicare-covered prosthetic devices
    Diabetes Programs and Supplies
    Authorization rules may apply.
    $0 copay for Medicare-covered Diabetes self-management training
    0% to 20% of the cost for Medicare-covered Diabetes monitoring supplies
    20% of the cost for Medicare-covered Therapeutic shoes or inserts
    Diagnostic Tests, X-Rays, Lab Services, and Radiology Services
    Authorization rules may apply.
    $0 copay for Medicare-covered lab services
    $0 copay for Medicare-covered diagnostic procedures and tests
    $0 copay for Medicare-covered X-rays
    $25 to $125 copay for Medicare-covered diagnostic radiology services (not including X-rays)
    20% of the cost for Medicare-covered therapeutic radiology services
    If the doctor provides you services in addition to Outpatient Diagnostic Procedures Tests and Lab Services separate cost sharing of $0 to $45 may apply
    If the doctor provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services separate cost sharing of $0 to $45 may apply
    ** Preventive Services **
    Cardiac and Pulmonary Rehabilitation Services
    $45 to $250 copay for Medicare-covered Cardiac Rehabilitation Services
    $45 to $250 copay for Medicare-covered Intensive Cardiac Rehabilitation Services
    $45 to $250 copay for Medicare-covered Pulmonary Rehabilitation Services
    Preventive Services and Wellness/Education Programs
    Authorization rules may apply.
    $0 copay for all preventive services covered under Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare.
    Authorization rules may apply.
    The plan covers the following supplemental education/wellness programs:
    • Health Club Membership/Fitness Classes
    Kidney Disease and Conditions
    Authorization rules may apply.
    20% of the cost for Medicare-covered renal dialysis
    $0 copay for Medicare-covered kidney disease education services
    Outpatient Prescription Drugs
    Most drugs not covered.
    20% of the cost for Medicare Part B chemotherapy drugs and other Part B drugs.
    This plan does not offer prescription drug coverage.
    Dental Services
    $0 copay for Medicare-covered dental benefits
    • $0 copay for up to 1 oral exam(s) every year
  • $0 copay for up to 2 cleaning(s) every year
  • $0 copay for up to 2 fluoride treatment(s) every year
  • $0 to $75 copay for up to 1 dental x-ray(s)
    • Hearing Services
    $0 copay for Medicare-covered diagnostic hearing exams
    $0 copay for:
    • up to 1 supplemental routine hearing exam(s) every two years
    $0 copay for up to 1 hearing aid fitting-evaluation(s) every two years
    $0 copay for up to 1 hearing aid(s) every two years
    $500 plan coverage limit for hearing aids every two years.
    ** Additional Benefits **
    Vision Services
    • $10 copay for one pair of Medicare-covered eyeglasses or contact lenses after cataract surgery.
  • $0 copay for Medicare-covered exams to diagnose and treat diseases and conditions of the eye.
  • $0 copay for up to 1 supplemental routine eye exam(s) every year
  • $10 copay for up to 1 pair(s) of glasses every year
  • $10 copay for up to 1 pair(s) of contacts every year
    • $100 plan coverage limit for eye wear every year.
    Plan offers additional vision benefits. Contact plan for details.
    Over-the-Counter Items
    The plan does not cover Over-the-Counter items.
    Transportation
    $0 copay for up to 4 one-way trip(s) to plan-approved location every year
    Acupuncture
    This plan does not cover Acupuncture.
    ** Inpatient Care **
    Inpatient Hospital Care
    Plan covers 90 days each benefit period.
    For Medicare-covered hospital stays:
    • Days 1 - 6: $335 copay per day
  • Days 7 - 90: $0 copay per day
    • Plan covers 60 lifetime reserve days. $0 copay per lifetime reserve day.
    Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.
    ** Outpatient Care **
    Doctor Office Visits
    Authorization rules may apply.
    $0 copay for each Medicare-covered primary care doctor visit.
    $45 copay for each Medicare-covered specialist visit.
    Outpatient Services
    Authorization rules may apply.
    $50 copay for each Medicare-covered ambulatory surgical center visit
    $250 copay for each Medicare-covered outpatient hospital facility visit
    Ambulance Services
    Authorization rules may apply.
    $100 copay for Medicare-covered ambulance benefits.
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    Authorization rules may apply.
    20% of the cost for Medicare-covered durable medical equipment
    Diagnostic Tests, X-Rays, Lab Services, and Radiology Services
    Authorization rules may apply.
    $0 copay for Medicare-covered lab services
    $0 copay for Medicare-covered diagnostic procedures and tests
    $0 copay for Medicare-covered X-rays
    $25 to $125 copay for Medicare-covered diagnostic radiology services (not including X-rays)
    20% of the cost for Medicare-covered therapeutic radiology services
    If the doctor provides you services in addition to Outpatient Diagnostic Procedures Tests and Lab Services separate cost sharing of $0 to $45 may apply
    If the doctor provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services separate cost sharing of $0 to $45 may apply
    ** Additional Benefits **
    Over-the-Counter Items
    The plan does not cover Over-the-Counter items.
    Transportation
    $0 copay for up to 4 one-way trip(s) to plan-approved location every year




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