Liberty Medicare Dual Plan (D-SNP) Plan Details for Robeson County, NC
This page provides coverage and cost details for Liberty Medicare Advantage’s H6351-005-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.
*This plan is new and has not yet been rated by CMS.
This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
Individuals must meet all Dual-Eligible SNP qualification requirements to join this D-SNP plan.
Liberty Medicare Dual Plan Basic Plan Details
- Plan ID
- H6351-005-0
- Plan Type
- HMO D-SNP
- Plan Year
- 2025
- Premium
- $24.30/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 7,550.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Basic
$590.00 deductible - Supplemental Benefits
- Vision, Hearing
- Availability
- Robeson County, NC
- Insured By
- Liberty Medicare Advantage
| Summary of Benefits |
|---|
Health Plan Out-of-Pocket Costs
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Liberty Medicare Advantage plan:
Doctor's Office Visits
- Primary
- 20% Coinsurance
- Specialist
- 20% Coinsurance
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- 20% Coinsurance
- Urgent care
- 20% Coinsurance
- Ground ambulance
- 20% Coinsurance
- Inpatient hospital care
- Coming Soon
- Skilled Nursing Facility
- Unknown
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- 20% Coinsurance
- Routine Foot Care
- Not Covered
Chiropractic Care
- Medicare-covered chiropractic
- 20% Coinsurance
Prior Authorization Required - Routine chiropractic
- Not Covered
Mental Health Services
- Outpatient individual therapy
- 20% Coinsurance
- Outpatient group therapy
- 20% Coinsurance
- Inpatient psychiatric hospital care
- Coming Soon
Rehabilitation Services
- Physical therapy and speech and language therapy
- 20% Coinsurance
Prior Authorization Required - Occupational therapy
- 20% Coinsurance
Prior Authorization Required
Medical Equipment and Supplies
- Diabetes supplies
- 20% Coinsurance
Prior Authorization Required - Durable medical equipment
- 20% Coinsurance
Prior Authorization Required - Prosthetics
- 20% Coinsurance
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- 20% Coinsurance
Prior Authorization Required - Lab services
- 20% Coinsurance
Prior Authorization Required - Outpatient x-rays
- 20% Coinsurance
Prior Authorization Required - Diagnostic tests and procedures
- 20% Coinsurance
Prior Authorization Required
Medicare Part B Drugs
- Chemotherapy
- 20% Coinsurance
- Other Part B drugs (Medicare-covered)
- 20% Coinsurance
Dental Services
- Medicare Covered Preventive Dental
- 20% Coinsurance
- Oral exam
- $0
- Dental x-rays
- $0
- Cleaning
- $0
- Periodontics
- Not Covered
- Endodontics
- Not Covered
- Restorative Services
- Not Covered
- Maximum dental benefit
- $2,500.00 (Every year)
Hearing Aids and Services
- Fitting/evaluation
- Covered
Limits may apply - Hearing aids
- Covered
Limits may apply - Hearing exam
- Covered
Limits may apply
Vision Services
- Medicare-covered eye exam
- Routine eye exam
- Covered
Limits may apply - Eyewear benefits
- None
Prescription Drug Costs & Benefits
Liberty Medicare Dual Plan includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
Prescription Drug Premium with Extra Help
Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| Low Income Premium Subsidy CMS Pays: | $24.30 |
| Low Income Subsidy Premium: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Deductible
The Medicare Part D annual deductible with this plan is $590.00. You must pay this amount at the pharmacy before Liberty Medicare Advantage begins paying its share.
Prescription Drug Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Liberty Medicare Dual Plan has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Cost data not available. | ||
| *The Part D deductible does not apply. | ||
CMS Rating Marks
Each year Medicare rates D-SNP plans, using a 5-star rating system, in nine major categories. These ratings are designed to help you understand the quality of care and service you can expect if you qualify and choose to join Liberty Medicare Dual Plan .
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
| Managing Chronic (Long Term) Conditions | Not enough data available |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify to Enroll in
Liberty Medicare Dual Plan
To qualify for enrollment in Liberty Medicare Dual Plan in Robeson County, you must be eligible for both Medicare and Medicaid. To be eligible for Medicare, you must be age 65 or older, or have Social Security Disability Insurance for 24 months. To be eligible for Medicaid, your income and assets must be at or below North Carolina's state thresholds.
Before enrolling in Liberty Medicare Dual Plan , or any other dual-eligible SNP, be sure to ask the following questions:
- What costs should I expect to pay out-of-pocket (premiums, deductibles, copayments)?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary? What if I can't afford my medications?
- What special accommodations does the plan make for persons with disabilities?
- Does the plan offer free meal delivery after a stay in the hospital?
- What help is offered for caregivers? Is adult day care covered?
- Does the plan offer a prepaid card for over the counter medications and covered groceries?
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
Contact Us About Liberty Medicare Advantage
| Website: | Liberty Medicare Advantage Plan Page (opens in new tab) |
|---|---|
| Providers: | Liberty Medicare Advantage Providers Page (opens in new tab) |
| Formulary: | Liberty Medicare Advantage Formulary Page (opens in new tab) |
| Pharmacy: | Liberty Medicare Advantage Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (833)354-1498 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (833)354-1498 |
| New Member Part D TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Health Plan Compatibility
Medicare Advantage Special Needs Plans (SNPs) are generally incompatible with most other health insurance options. Enrolling in an SNP plan while having Medicare Part A and/or Medicare Part B will result in disenrollment from Original Medicare. Additionally, it is not possible to simultaneously hold a Medicare Supplement Insurance policy and be part of an SNP plan.
With a D-SNP, members keep the same Medicaid plan and Medicaid benefits. If you are a Veteran and have VA Health Benefits, you may be able to care from your local VA hospital.
Citations & References
- Liberty Medicare Advantage, http://www.LibertyMedicareAdvantage.com, Last Accessed October 13, 2024
- Medicaid.gov, "Medicaid & CHIP in North Carolina", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
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