2022 Liberty Medicare Advantage Nursing Home Plan
- Enrollment Form
- Evidence of Coverage
- Pre-Enrollment Checklist
- Summary of Benefits
- Comprehensive Formulary – Last updated 08/01//2022
- Pharmacy Prior Authorization – Last updated 08/01/2022
- Step Therapy Criteria – Last updated 08/01/2022
- Pharmacy Directory
- Request for Redetermination of Medicare Prescription Drug Denial
- Request for Prescription Drug Coverage Determination
- Medication Therapy Management Program
- Prescription Drug Transition Policy
- Request for Authorization
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) is an Institutional Special Needs Plans (I-SNP) dedicated to providing personalized care to their members. All members get more than what is covered by Original Medicare. Under Liberty Medicare Advantage Nursing Home Plan, you will receive all benefits covered under Medicare Part A and Part B, Medicare Part D Prescription Drug Coverage, and many supplemental benefits such as routine hearing and eye exams. Additionally, when you enroll in Liberty Medicare Advantage Nursing Home Plan, a customized care team, supported by a nurse practitioner or physician will develop, enact, and coordinate your personal care plan. If you or your loved one is eligible, Liberty Medicare Advantage Nursing Home Plan can greatly improve the care you receive, resulting in better health and well-being. If you reside in a Nursing Home or Assisted Living Facility this plan was built for you.
Membership advantages include:
- Medicare Part D Prescription Drug Coverage
- Preventative screenings
- Regular visits from a nurse practitioner or physician with the goal of better care coordination and more personalized care which leads to fewer unwanted trips to the hospital
- A personalized care plan that ensures that you are receiving the best and most appropriate care possible
- Open communication between you, your family, your care team, and nursing facility staff
- One point of contact for communication between you, your family, your care team, and nursing facility staff
You have choices with Liberty Medicare Advantage Nursing Home Plan
You are eligible to join Liberty Medicare Advantage Nursing Home Plan if you have Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), and meet Liberty Medicare Advantage Nursing Home Plan’s eligibility requirements. Liberty Medicare Advantage Nursing Home Plan is best suited for people who reside in one of our participating assisted living communities and meet a nursing facility level of care or reside in one of our participating nursing facilities for greater than 90 days.
2022 I-SNP Benefit Highlights
How much is the monthly premium?
$35.80 per month. You also must keep paying your Medicare Part B premium.
How much is the deductible?
$203 per year for in-network services.
$480 per year for Part D prescription drugs.
Is there a Maximum Out-Of-Pocket Cost per year?
Yes, similarly to all Medicare plans, we protect you by establishing a maximum amount that you will pay out of pocket for covered services. The yearly Maximum Out-Of-Pocket Cost is $6,600.
After reaching this limit, the plan will pay for all covered services and procedures. Please note: you will still have to pay your monthly premiums and cost-sharing for Part D prescription drugs.
Is there a limit on how much the plan will pay?
The plan does have a yearly coverage limit for certain in-network benefits. Please contact us for more information.
Below is a chart of Benefits that our plan offers. These Benefits are provided in addition to all Original Medicare benefits.
|Podiatry||$0 Copay for 4 routine foot care visits per year|
|Hearing||Routine hearing exam and hearing aid fitting and contribution towards hearing aids.|
|Vision||Routine eye exam and eyewear allowance.|
|Transportation||$0 Copay for 20 one-way trips per year for non-emergency medical services|
|Primary Care Visits||$0 Copay for Primary Care visits|
|Skilled Nursing||No prior hospitalization required for a skilled nursing stay|
The Open Enrollment for Institutionalized Individuals (OEPI) is continuous for eligible individuals. You may enroll in Liberty Medicare Advantage at any time if you are eligible.
You can join Liberty Medicare Advantage if you have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), reside in or are expected to reside in a participating Liberty Medicare Advantage facility for 90 days or longer, and meet Liberty Medicare Advantage’s eligibility requirements.
Alamance, Bladen, Buncombe, Chatham, Cumberland, Forsyth, Guilford, Hyde, Lee, New Hanover, Person, Rowan, Scotland, Watauga, Warren, Yadkin, Bertie, Brunswick, Catawba, Columbus, Davie, Franklin, Halifax, Johnston, Orange County, Robeson, Sampson, and Wake
Participating Nursing Facilities:
Bermuda Commons Nursing & Rehabilitation Center
Capital Nursing & Rehabilitation Center
Liberty Commons Nursing & Rehabilitation Center of Columbus County
Liberty Commons Nursing & Rehabilitation Center
Southwood Nursing & Rehabilitation Center
Liberty Commons Nursing & Rehabilitation Center of Johnston County
Mary Gran Nursing Center
Pisgah Manor Nursing & Rehabilitation Center
Summerstone Health and Rehabilitation Center
Three Rivers Health & Rehabilitation Center
Woodlands Nursing & Rehabilitation Center
Southport Health and Rehabilitation Center
Liberty Commons Nursing & Rehabilitation Center of Alamance County
Liberty Commons Nursing & Rehabilitation Center of Lee County
Parkview Health & Rehabilitation Center
Shoreland Health Care & Retirement Center
Commons at Brightmore
Warren Hills Rehabilitation & Nursing Center
Bradley Creek Health Center at Carolina Bay
Golden Years Nursing Center
Liberty Commons Nursing & Rehabilitation Center (Racine)
Liberty Commons Nursing & Rehabilitation Center of Halifax County
Liberty Commons Nursing & Rehabilitation Center of Rowan County
Scottish Pines Nursing & Rehabilitation Center
Westfield Rehabilitation and Health Center
Louisburg Healthcare & Rehab Center
Elizabethtown Healthcare & Rehab
Roxboro Healthcare & Rehab
Oak Forest Health & Rehab
Yadkin Nursing Care Center
The Foley Center of Chestnut Ridge
Ready to Enroll in Liberty Advantage?
If you meet the eligibility criteria, you can enroll at any time, effective the first of the following month.
Call 1-844-854-6884 (TTY 711) to speak with a Liberty Medicare Advantage Representative, or click to download an Enrollment Form below and mail it to us at PO Box 3630, Little Rock, AR 72202.
You can search for Drug Take Back programs near you: https://scdhec.gov/household-medicinepharmaceutical-disposal