FirstMedicare Direct POS Choice (HMO-POS) H6306-015 is a 2023 Medicare Advantage Plan or Part-C by FirstMedicare Direct available to residents in North Carolina. This plan does not provide extra prescription drug (Part-D) coverage. FirstMedicare Direct FirstMedicare Direct POS Choice (HMO-POS) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,000 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $5,000 out-of-pocket. This can be an extremely nice safety net.

FirstMedicare Direct works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for FirstMedicare Direct POS Choice (HMO-POS) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from FirstMedicare Direct and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from FirstMedicare Direct except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in North Carolina.

2023 FirstMedicare Direct Medicare Advantage Plan Overview

What type of plan is FirstMedicare Direct POS Choice (HMO-POS)

FirstMedicare Direct POS Choice (HMO-POS) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your primary care physician will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.

With a HMO-POS point-of-service you have the option to go out-of-network or see a specialist without a referral. But, you may pay more for out-of-network care you receive than from an in-network provider.

How much does FirstMedicare Direct POS Choice (HMO-POS) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. FirstMedicare Direct charges a $0 premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. FirstMedicare Direct POS Choice (HMO-POS) by FirstMedicare Direct MOOP is $5,000. Once you spend $5,000 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.

2023 Summary of Benefits

The benefit information provided is a summary of what FirstMedicare Direct POS Choice (HMO-POS) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from FirstMedicare Direct helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)	Covered

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Contact lenses

Out-of-Network Vision	$0 copay
In-Network Vision	$0 copay

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Eyeglass frames

In-Network Vision	$0 copay
Out-of-Network Vision	$0 copay

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Eyeglass lenses

Out-of-Network Vision	$0 copay
In-Network Vision	$0 copay

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Eyeglasses (frames and lenses)

Out-of-Network Vision	$0 copay
In-Network Vision	$0 copay

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Other

Vision	Not covered

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Routine eye exam

Out-of-Network Vision	$0 copay
In-Network Vision	$0 copay

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Upgrades

Out-of-Network Vision	$0 copay
In-Network Vision	$0 copay

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Transportation	Not covered
Out-of-Network Skilled Nursing Facility	30% per stay
In-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $196 per day for days 21 through 100

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Occupational therapy visit

In-Network Rehabilitation services	$30 copay
Out-of-Network Rehabilitation services	30% coinsurance

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Physical therapy and speech and language therapy visit

In-Network Rehabilitation services	$30 copay
Out-of-Network Rehabilitation services	30% coinsurance

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Cleaning

Out-of-Network Preventive dental	$0 copay
In-Network Preventive dental	$0 copay

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Dental x-ray(s)

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	$0 copay

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Fluoride treatment

Preventive dental	Not covered

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Oral exam

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	$0 copay

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Out-of-Network Preventive care	$0 copay
In-Network Preventive care	$0 copay
Out-of-Network Outpatient hospital coverage	30% coinsurance per visit
In-Network Outpatient hospital coverage	$250 copay per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

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Inpatient hospital - psychiatric

In-Network Mental health services	$160 per day for days 1 through 10 $0 per day for days 11 through 90
Out-of-Network Mental health services	30% per stay

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Outpatient group therapy visit

In-Network Mental health services	$40 copay
Out-of-Network Mental health services	30% coinsurance

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Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	$40 copay
Out-of-Network Mental health services	30% coinsurance

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Outpatient individual therapy visit

In-Network Mental health services	$40 copay
Out-of-Network Mental health services	30% coinsurance

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Outpatient individual therapy visit with a psychiatrist

In-Network Mental health services	$40 copay
Out-of-Network Mental health services	30% coinsurance

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Chemotherapy

Out-of-Network Medicare Part B drugs	20% coinsurance
In-Network Medicare Part B drugs	20% coinsurance

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Other Part B drugs

Out-of-Network Medicare Part B drugs	20% coinsurance
In-Network Medicare Part B drugs	20% coinsurance

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Diabetes supplies

Out-of-Network Medical equipment/supplies	20% coinsurance per item
In-Network Medical equipment/supplies	0-20% coinsurance per item

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Durable medical equipment (e.g., wheelchairs, oxygen)

Out-of-Network Medical equipment/supplies	20% coinsurance per item
In-Network Medical equipment/supplies	20% coinsurance per item

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Prosthetics (e.g., braces, artificial limbs)

Out-of-Network Medical equipment/supplies	20% coinsurance per item
In-Network Medical equipment/supplies	20% coinsurance per item

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$8,950 In and Out-of-network $5,000 In-network
In-Network Inpatient hospital coverage	$295 per day for days 1 through 6 $0 per day for days 7 through 90
Out-of-Network Inpatient hospital coverage	30% per stay

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Fitting/evaluation

In-Network Hearing	$0 copay

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Hearing aids

In-Network Hearing	$495-1,695 copay

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Hearing exam

In-Network Hearing	$30 copay
Out-of-Network Hearing	$65 copay

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Health plan deductible	$0
In-Network Ground ambulance	$350 copay

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Foot exams and treatment

In-Network Foot care (podiatry services)	$30 copay
Out-of-Network Foot care (podiatry services)	$65 copay

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Routine foot care

Foot care (podiatry services)	Not covered

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Emergency

Emergency care/Urgent care	$110 copay per visit (always covered)

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Urgent care

Emergency care/Urgent care	$10 copay per visit (always covered)

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Primary

Out-of-Network Doctor visits	30% coinsurance per visit
In-Network Doctor visits	$0 copay

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Specialist

Out-of-Network Doctor visits	$65 copay per visit
In-Network Doctor visits	$30 copay per visit

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Diagnostic radiology services (e.g., MRI)

In-Network Diagnostic procedures/lab services/imaging	$275 copay
Out-of-Network Diagnostic procedures/lab services/imaging	30% coinsurance

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Diagnostic tests and procedures

In-Network Diagnostic procedures/lab services/imaging	$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging	30% coinsurance

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Lab services

Out-of-Network Diagnostic procedures/lab services/imaging	30% coinsurance
In-Network Diagnostic procedures/lab services/imaging	$0 copay

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Outpatient x-rays

In-Network Diagnostic procedures/lab services/imaging	$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging	30% coinsurance

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Diagnostic services

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

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Endodontics

Out-of-Network Comprehensive dental	$0 copay
In-Network Comprehensive dental	$0 copay

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Extractions

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

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Non-routine services

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

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Periodontics

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

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Prosthodontics, other oral/maxillofacial surgery, other services

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

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Restorative services

Out-of-Network Comprehensive dental	$0 copay
In-Network Comprehensive dental	$0 copay

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In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	No

FirstMedicare Direct POS Choice (HMO-POS) Reviews

Is FirstMedicare Direct POS Choice (HMO-POS) a good plan? FirstMedicare Direct POS Choice (HMO-POS) received a 4 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare FirstMedicare Direct POS Choice Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H6306-015 Health Plan

Member Complaints and Changes in Plans Performance

Health Plan Customer Service Rating for FirstMedicare Direct

Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for FirstMedicare Direct POS Choice (HMO-POS) requires you to live in that plan’s service area. The service area is listed below:

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Source:CMS. Data as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.