Freedom Savings Plan (HMO)
H5427 - 052 - 0
(4.5 / 5)
Freedom Savings Plan (HMO) is a Medicare Advantage (Part C) Plan by Freedom Health, Inc..
This page features plan details for 2024 Freedom Savings Plan (HMO) H5427 – 052 – 0 available in Select Counties in Florida.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Freedom Savings Plan (HMO) is offered in the following locations.
Plan Overview
Freedom Savings Plan (HMO) offers the following coverage and cost-sharing.
| Insurer: | Freedom Health, Inc. |
| Health Plan Deductible: | $0.00 |
| MOOP: | $3,400 In-network |
| Drugs Covered: | No |
Ready to sign up for Freedom Savings Plan (HMO) ?
Medicare Part B Give Back Benefit
The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.
Freedom Savings Plan (HMO) qualifies for a monthly Medicare Give Back Benefit of $75.00.
| Premium Reduction: | $75.00 |
Premium Breakdown
Freedom Savings Plan (HMO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $0.00 | $75.00 | $99.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Freedom Savings Plan (HMO) also provides the following benefits.
| $0 |
| In-network | No |
| $3,400 In-network |
| No |
| In-network | No |
| $195 copay per visit (Authorization is required.) (Referral is required.) |
| Primary | $0 copay (Not applicable.) (Not applicable.) |
| Specialist | $40 copay per visit (Authorization is required.) (Referral is required.) |
| $0 copay (Authorization is required.) (Referral is required.) |
| Emergency | $120 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $10 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Diagnostic tests and procedures | $0-195 copay or 20% coinsurance (Authorization is required.) (Referral is required.) |
| Lab services | $0-50 copay (Authorization is required.) (Referral is required.) |
| Diagnostic radiology services (e.g., MRI) | $25-195 copay (Authorization is required.) (Referral is required.) |
| Outpatient x-rays | $0-195 copay (Authorization is required.) (Referral is required.) |
| Hearing exam | $0 copay (Authorization is not required.) (Referral is not required.) |
| Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Hearing aids | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Non-routine services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is required.) |
| Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Periodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Extractions | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is required.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Contact lenses | $10 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglasses (frames and lenses) | $10 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Upgrades | $30 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Occupational therapy visit | $40 copay (Authorization is required.) (Referral is required.) |
| Physical therapy and speech and language therapy visit | $40 copay (Authorization is required.) (Referral is required.) |
| $150 copay (Not applicable.) (Not applicable.) |
| $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Foot exams and treatment | $40 copay (Authorization is required.) (Referral is required.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Diabetes supplies | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Part B Insulin drugs | $35 copay (Authorization is required.) (Not applicable.) |
| $225 per day for days 1 through 7 $0 per day for days 8 through 90 (Authorization is required.) (Referral is required.) |
| Inpatient hospital – psychiatric | $225 per day for days 1 through 7 $0 per day for days 8 through 90 (Authorization is required.) (Referral is required.) |
| Outpatient group therapy visit with a psychiatrist | $40 copay (Authorization is required.) (Referral is required.) |
| Outpatient individual therapy visit with a psychiatrist | $40 copay (Authorization is required.) (Referral is required.) |
| Outpatient group therapy visit | $40 copay (Authorization is required.) (Referral is required.) |
| Outpatient individual therapy visit | $40 copay (Authorization is required.) (Referral is required.) |
| $0 per day for days 1 through 5 $20 per day for days 6 through 20 $125 per day for days 21 through 100 (Authorization is required.) (Referral is required.) |
Ready to sign up for Freedom Savings Plan (HMO) ?
Table of Contents
SMID: MULTIPLAN_HCIHNDOGMED01_M
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