2024 Liberty Medicare Advantage Nursing Home Plan
- Evidence of Coverage
- Summary of Benefits
- Comprehensive Formulary
- 1-Tier ST
- 1-Tier PA
- 1-Tier Comp Form
- Pharmacy Directory
- Request for Authorization
- Authorization Chart
- Annual Notice of Changes
- IRA Addendum
- LMA Medication Therapy Management (MTM) Program
- MTM Program Standard Format Letter
- Notification of Availability of Electronic Materials
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.
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.
- 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.
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.
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 Nursing & Rehabilitation Center
Capital Nursing & Rehabilitation Center
Liberty Commons Nursing & Rehabilitation Center of Columbus County
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
Warren Hills Rehabilitation & Nursing Center
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
Highland House Rehabilitation & Healthcare
Pinehurst Healthcare & Rehab 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.