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Freedom Savings Plan (HMO) - H5427-052-000
$0.00
Monthly Premium
Freedom Savings Plan (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Freedom Health Inc.
Plan ID: H5427-052-000
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$0.00
Monthly Premium
Florida Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.
Most Medicare Advantage plans cover prescription drugs, and many plans may offer other additional benefits Original Medicare doesn’t cover.
Learn more about Florida Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.
Enrollment may be limited to certain times of the year. See why you may be able to enroll today.
Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $0.00 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | -$1.00 |
| Out-of-pocket maximum | $4,200.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $2,100.00 |
| Primary care doctor visit | In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $0 |
| Specialty doctor visit | In-Network: $40.00 copay |
| Inpatient hospital care | In-Network: Days 1-7: $225.00 per day, per admission / Days 8-90: $0.00 per day, per admission |
| Urgent care | Urgent Care: $10.00 copay |
| Emergency room visit | Emergency Care: $150.00 copay Copay waived if admitted to hospital within 72 hours Worldwide Coverage: This plan covers urgent care and emergency services, including emergency transportation, when traveling outside of the United States for less than six months. This benefi |
| Ambulance transportation | In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $200 Air Ambulance: Coinsurance for Air Ambulance Services 20% Prior Authorization Required for Air Ambulance |
Health Care Services and Medical Supplies
Freedom Savings Plan (HMO) covers a range of additional benefits. Learn more about Freedom Savings Plan (HMO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).
| Coverage | Details |
|---|---|
| Chiropractic services | In-Network: Medicare Covered Chiropractic Services: $20.00 copay |
| Diabetes supplies, training, nutrition therapy and monitoring | In-Network: Diabetic Supplies: 0% coinsurance - 20% |
| Durable medical equipment (DME) | In-Network: 20% coinsurance |
| Diagnostic tests, lab and radiology services, and X-rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Copayment for Medicare-covered Diagnostic Procedures/Tests $0 to $195 Coinsurance for Medicare-covered Diagnostic Procedures/Tests 20% Copayment for Medicare-covered Lab Services $0 to $50 Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services Referral Required for Outpatient Diag Procs/Tests/Lab Services The minimum copay applies to all outpatient diagnostic procedures and tests (except sleep study) at a freestanding provider. The maximum copay applies to all outpatient diagnostic procedures and tests (except sleep study) in an outpatient hospital setting.The coinsurance applies to sleep studies at a freestanding provider or outpatient hospital setting. Outpatient Diag/Therapeutic Rad Services: Copayment for Medicare-covered Diagnostic Radiological Services $25 to $195 Coinsurance for Medicare-covered Therapeutic Radiological Services 20% Copayment for Medicare-covered X-Ray Services $0 to $195 |
| Home health care | In-Network: $10.00 copay |
| Mental health inpatient care | In-Network: Days 1-7: $225.00 per day, per admission / Days 8-90: $0.00 per day, per admission |
| Mental health outpatient care | In-Network: Individual and Group Sessions: $40.00 copay |
| Outpatient services/surgery | In-Network: Outpatient Hospital - Surgery: $195.00 copay Observation Services: $195.00 copay Ambulatory Surgical Center: $50.00 copay |
| Outpatient substance abuse care | In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $40 to $195 Copayment for Medicare-covered Group Sessions $40 to $195 Prior Authorization Required for Outpatient Substance Abuse Services Referral Required for Outpatient Substance Abuse Services The minimum copay applies to outpatient substance abuse services received at a office or free-standing provider. The maximum copay applies to outpatient substance abuse services received at a hospital based provider. |
| Over-the-counter items | This plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $35 every month. Unused OTC amounts expire at the end of each month. |
| Podiatry services | In-Network: Medicare Covered Podiatry Services: $40.00 copay |
| Skilled Nursing Facility (SNF) care | In-Network: Days 1 - 20: $0.00 per day / Days 21 - 100: $218.00 per day |
Dental Benefits
The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Dental care | In-Network: Preventive Dental Services: $0.00 copay This plan covers: 2 oral exams, 2 emergency exams, 2 prophylaxis cleanings, 2 fluoride treatments and dental X-rays every year. Medicare Covered Dental: $0.00 copay Comprehensive Dental Services: $0.00 copay This plan covers up to: 2 simple or surgical extractions (in 1 or more visits). |
Vision Benefits
The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage
| Coverage | Details |
|---|---|
| Vision care | In-Network: Medicare Covered Eye Exam: $0.00 copay Routine Eye Exam: $0.00 copay This plan covers 1 routine eye exam(s) every year. Medicare Covered Eye Wear: $0.00 copay Routine Eye Wear: $10.00 copay and $30 This plan covers up to $100 for 1 pair(s) of eyeglasses or contact lenses every |
Hearing Benefits
The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Hearing care | In-Network: Medicare Covered Hearing Exam: $0.00 copay Routine Hearing Exam: $0.00 copay for routine hearing exam(s). $0.00 copay for hearing aids up to the maximum plan benefit amount. This plan covers 1 routine hearing exam every year. This plan covers 1 routine hearing aid fitting evaluation and a $500 maximum plan benefit for prescribed hearing aids per ear every year. |
Preventive Services and Health/Wellness Education Programs
The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Preventive services and health/wellness education programs | In-Network: $0.00 copay for Medicare Covered Preventive Services: Abdominal aortic aneurysm screening Alcohol misuse screenings & counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Cervical & vaginal cancer screening Colorectal cancer screenings Depression screenings Diabetes screenings Diabetes self-management training Glaucoma tests Hepatitis B (HBV) infection screening Hepatitis C screening test HIV screening Lung cancer screening Mammograms (screening) Nutrition therapy services Obesity screenings & counseling One-time Welcome to Medicare preventive visit Prostate cancer screenings(PSA) Sexually transmitted infections screening & counseling Shots:
Yearly "Wellness" visit |
When reviewing Florida Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.
You may be able to find plans in your part of Florida that offer similar benefits at similar or lower prices than the plan above. Call 1-888-876-5731 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.
Plan Documents
| Links to plan documents |
Florida Counties Served
We offer plans from Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield*, Aetna, Healthspring, Wellcare, or Kaiser Permanente.
Enrollment may be limited to certain times of the year. See why you may be able to enroll today.