2022 Liberty Medicare Dual 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 Dual Plan (HMO D-SNP) is a Dual Special Needs Plan for individuals who are entitled to both Medicare and medical assistance from North Carolina Medicaid.
2022 D-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?
$0 per year for in-network services.
$0 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 $7,550.
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.
The Open Enrollment for Institutionalized Individuals (OEPI) is continuous for eligible individuals. You may enroll in Liberty Advantage at any time if you are eligible.
You can join Liberty 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 Advantage facility for 90 days or longer, and meet Liberty 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 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