2024 Liberty Medicare Advantage Nursing Home Plan
Documents
- Evidence of Coverage , updated 1/1/2024
- Summary of Benefits , updated 1/1/2024
- Formulary , updated 11/1/2024
- Multi Language Insert , updated 1/1/2024
- Pharmacy Directory , updated 1/1/2024
- Request for Authorization , updated 1/1/2024
- Authorization Chart , updated 1/1/2024
- Annual Notice of Changes , updated 1/1/2024
- IRA Addendum , updated 1/1/2024
- LMA Medication Therapy Management (MTM) Program , updated 1/1/2024
- MTM Program Standard Format Letter , updated 1/1/2024
- Notification of Availability of Electronic Materials , updated 1/1/2024
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) is an Institutional Special Needs Plans (I-SNP) dedicated to providing personalized care to our members. 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:
- Nurse Practitioner + Care Team – Personalized on-site visits and clinical care coordinator
- Podiatry – $0 copay for up to 4 annual routine foot care visits
- Hearing – $0 copay for Routine hearing exam, hearing aid fittings, and contribution for hearing aids up to $2,800 every two years
- Vision – $0 copay for Routine eye exam and $350 annual contribution for eyewear
- Skilled Nursing
- $0 copay per days 1-20 per benefit period $200.00 per day for days 21- 100 per benefit period. You pay all costs for each day after day 100.
- A benefit period begins on the first day you go to a Medicare covered in-patient hospital or a skilled nursing facility.
- The benefit period ends when you haven’t been inpatient at any hospital or SNF for 60 days in a row.
- If you go to the hospital or SNF after 1 benefit period has ended, a new benefit period begins.
- There is no limit to the number of benefit periods you can have.
- Non-Emergency Transportation – $0 copay for 55 one-way trips for non-emergency health services
- Primary Care Physician – $0 copay
Additional Membership advantages include:
- 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
- Concierge Service from our Member Advocate if you have any questions on Claims, Pharmacy or benefits.
Eligibility Requirements
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.
2024 I-SNP Benefit Highlights
How much is the monthly premium?
$38.40 per month. You also must keep paying your Medicare Part B premium.
How much is the deductible?
$226 per year for in-network services – these may change in 2024
$545 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.
Hearing Services
- 0% coinsurance for 1 routine exam and hearing aid fittings/evaluations. Up to $2,800 every two years for hearing aids (both ears)
- Vision Care: Bold Vision Care
- One routine eye exam annually as well as eye glasses, contact lenses or other vision hardware with a $350 limit.
Enrollment Period
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.
Service Area:
Our service area includes these counties in North Carolina: Alamance, Bertie, Bladen, Brunswick, Buncombe, Burke, Cabarrus, Caldwell, Catawba, Chatham, Columbus, Cumberland, Davidson, Davie, Durham, Forsyth, Franklin, Granville, Greene, Guilford, Harnett, Halifax, Henderson, Hyde, Johnston, Lee, Lenoir, Martin, Mecklenburg, Moore, New Hanover, Orange, Pender, Person, Pitt, Randolph, Richmond, Robeson, Rockingham, Rowan, Sampson, Scotland, Stokes, Vance, Union, Wake, Warren, Wayne, Watauga, Wilkes, Wilson, and Yadkin.
Participating Nursing Facilities:
Bermuda Commons Nrsg & Rehab Center
Capital Nursing & Rehab Center
Foley Center of Chestnut Ridge
Elizabethtown Healthcare & Rehab
Golden Years Nursing Center
Highland House Rehab & Healthcare
Liberty Commons Nrsg & Rehab Ctr (Racine)
Liberty Commons Nrsg & Rehab Ctr of Alamance Cty
Liberty Commons Nrsg & Rehab Ctr of Columbus Cty
Liberty Commons Nrsg & Rehab Ctr of Halifax Cty
Liberty Commons Nrsg & Rehab Ctr of Johnston Cty
Liberty Commons Nrsg & Rehab Ctr of Lee Cty
Liberty Commons Nrsg & Rehab Ctr of Rowan Cty
Louisburg Healthcare & Rehab Center
Mary Gran Nursing Center
Oak Forest Health & Rehab
Parkview Health & Rehabilitation Center
Pavilion Health Center at Brightmore
Pinehurst Healthcare & Rehab Center
Pisgah Manor Nursing & Rehab Center
Royal Park Rehab & Health Center
Roxboro Healthcare & Rehab
Scottish Pines Nursing & Rehab Center
Shoreland Health Care & Retirement Center
Silver Bluff Village
Southport Health & Rehab Center
Southwood Nursing & Rehab Center
Summerstone Health & Rehab Center
The Oaks
Three River Health & Rehab Center
Warren Hills Rehab & Nursing Center
Westfield Rehab & Health Center
Woodhaven Nursing & Rehab
Woodlands Nursing & Rehab Center
Yadkin Nursing Care Center
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 3325, Spring Hill, FL 34611.