New Hanover Health Advantage Freedom (HMO-POS) H6306-016 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 New Hanover Health Advantage Freedom (HMO-POS) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $4,500 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $4,500 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 New Hanover Health Advantage Freedom (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 New Hanover Health Advantage Freedom (HMO-POS)

New Hanover Health Advantage Freedom (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 New Hanover Health Advantage Freedom (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. New Hanover Health Advantage Freedom (HMO-POS) by FirstMedicare Direct MOOP is $4,500. Once you spend $4,500 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 New Hanover Health Advantage Freedom (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

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

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Eyeglass lenses

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

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Eyeglasses (frames and lenses)

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

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Other

Vision	Not covered

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Routine eye exam

In-Network Vision	$0 copay

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Upgrades

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

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In-Network Transportation	$0 copay
In-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $196 per day for days 21 through 41 $0 per day for days 42 through 100
Out-of-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $196 per day for days 21 through 41 $0 per day for days 42 through 100

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Occupational therapy visit

In-Network Rehabilitation services	$35 copay
Out-of-Network Rehabilitation services	$50 copay

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Physical therapy and speech and language therapy visit

Out-of-Network Rehabilitation services	$50 copay
In-Network Rehabilitation services	$35 copay

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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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In-Network Preventive care	$0 copay
Out-of-Network Preventive care	$0 copay
In-Network Outpatient hospital coverage	$300 copay per visit
Out-of-Network Outpatient hospital coverage	$450 copay per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

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Inpatient hospital - psychiatric

Out-of-Network Mental health services	$285 per day for days 1 through 10 $0 per day for days 11 through 90
In-Network Mental health services	$160 per day for days 1 through 10 $0 per day for days 11 through 90

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Outpatient group therapy visit

In-Network Mental health services	$35 copay
Out-of-Network Mental health services	$50 copay

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Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	$35 copay
Out-of-Network Mental health services	$50 copay

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Outpatient individual therapy visit

Out-of-Network Mental health services	$50 copay
In-Network Mental health services	$35 copay

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Outpatient individual therapy visit with a psychiatrist

Out-of-Network Mental health services	$50 copay
In-Network Mental health services	$35 copay

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Chemotherapy

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

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Other Part B drugs

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

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Diabetes supplies

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

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

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

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

In-Network Medical equipment/supplies	20% coinsurance per item
Out-of-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 $4,500 In-network
In-Network Inpatient hospital coverage	$300 per day for days 1 through 6 $0 per day for days 7 through 90
Out-of-Network Inpatient hospital coverage	$450 per day for days 1 through 6 $0 per day for days 7 through 90

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Fitting/evaluation

In-Network Hearing	$0 copay

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Hearing aids

In-Network Hearing	$0 copay

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Hearing exam

Out-of-Network Hearing	$50 copay
In-Network Hearing	$35 copay

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Health plan deductible	$0
Out-of-Network Ground ambulance	$265 copay
In-Network Ground ambulance	$265 copay

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Foot exams and treatment

Out-of-Network Foot care (podiatry services)	$50 copay
In-Network Foot care (podiatry services)	$35 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	$35 copay per visit (always covered)

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Primary

In-Network Doctor visits	$0 copay
Out-of-Network Doctor visits	$0 copay

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Specialist

Out-of-Network Doctor visits	$50 copay per visit
In-Network Doctor visits	$35 copay per visit

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Diagnostic radiology services (e.g., MRI)

In-Network Diagnostic procedures/lab services/imaging	$0-275 copay
Out-of-Network Diagnostic procedures/lab services/imaging	40% coinsurance

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Diagnostic tests and procedures

Out-of-Network Diagnostic procedures/lab services/imaging	40% coinsurance
In-Network Diagnostic procedures/lab services/imaging	$0-85 copay

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Lab services

In-Network Diagnostic procedures/lab services/imaging	$0-50 copay
Out-of-Network Diagnostic procedures/lab services/imaging	40% coinsurance

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Outpatient x-rays

Out-of-Network Diagnostic procedures/lab services/imaging	30% coinsurance
In-Network Diagnostic procedures/lab services/imaging	$0-100 copay

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Diagnostic services

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

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Endodontics

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

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Extractions

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

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

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Restorative services

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

New Hanover Health Advantage Freedom (HMO-POS) Reviews

Is New Hanover Health Advantage Freedom (HMO-POS) a good plan? New Hanover Health Advantage Freedom (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 New Hanover Health Advantage Freedom Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H6306-016 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 New Hanover Health Advantage Freedom (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.