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Ochsner Health Plan Heroes (HMO-POS)

H9763 - 006 - 0
3.5 out of 5 stars (3.5 / 5)

Ochsner Health Plan Heroes (HMO-POS) is a Medicare Advantage Plan by Ochsner Health Plan.

This page features plan details for 2025 Ochsner Health Plan Heroes (HMO-POS) H9763 – 006 – 0 available in New Orleans and Baton Rouge Areas.

Locations

Ochsner Health Plan Heroes (HMO-POS) is offered in the following locations.

Ascension County, Louisiana
East Baton Rouge County, Louisiana
East Feliciana County, Louisiana

Click to see more locations

Plan Overview

Ochsner Health Plan Heroes (HMO-POS) offers the following coverage and cost-sharing.

Insurer:Ochsner Health Plan
Health Plan Deductible:$0
MOOP:$4,450 In-network
$8,000 Out-of-network
Drugs Covered:No

Ready to sign up for Ochsner Health Plan Heroes (HMO-POS) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

Ochsner Health Plan Heroes (HMO-POS) qualifies for a monthly Medicare Give Back Benefit of $100.00.

Premium Reduction:$100.00

Premium Breakdown

Ochsner Health Plan Heroes (HMO-POS) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$185.00 $0.00 $100.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Ochsner Health Plan Heroes (HMO-POS) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: 25 Coins – No Co pay (Authorization Required)
  • Endodontics
    • In-Network: 25 Coins – No Co pay (Authorization Required)
  • Oral and Maxillofacial Surgery
    • In-Network: 25 Coins – No Co pay (Authorization Required)
  • Periodontics
    • In-Network: 25 Coins – No Co pay (Authorization Required)
  • Prosthodontics, removable
    • In-Network: 25 Coins – No Co pay (Authorization Required)
  • Restorative Services
    • In-Network: 25 Coins – No Co pay (Authorization Required)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay (Authorization Required)
  • Oral Exams
    • In-Network: No Coins – No Copay (Authorization Required)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay (Authorization Required)

Diagnostic procedures/lab services/imaging

  • Outpatient x-rays
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Lab services
    • In-Network: $0 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $50 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-125 copay (Authorization Required)
  • Lab services
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $10 copay (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)

Doctor visits

  • Primary
    • In-Network: $0 copay
  • Specialist
    • In-Network: $25 copay per visit
  • Primary
    • Out-of-Network: 20% coinsurance per visit
  • Specialist
    • Out-of-Network: 20% coinsurance per visit

Emergency care/Urgent care

  • Urgent care
    • $35 copay per visit (always covered)
  • Emergency
    • $125 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $25 copay (Authorization Required)
  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • Out-of-Network: 20% coinsurance (Authorization Required)

Ground ambulance

    • In-Network: $235 copay
    • Out-of-Network: 20% coinsurance

Health plan deductible

    • $0

Hearing

  • Hearing aids OTC
    • Not covered
  • Medicare-Covered Hearing Exam
    • In-Network: $20 copay
  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply)
  • Hearing aids
    • In-Network: $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • Out-of-Network: 20% coinsurance

Inpatient hospital coverage

    • Out-of-Network: 20% per stay (Authorization Required)
    • In-Network: $175 per day for days 1 through 10
      $0 per day for days 11 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $4,450 In-network
      $8,000 Out-of-network

Medical equipment/supplies

  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • In-Network: $0 copay or 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 0-20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)

Mental health services

  • Outpatient group therapy visit
    • In-Network: $25 copay (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Outpatient group therapy visit
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $25 copay (Authorization Required)
  • Outpatient individual therapy visit
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Inpatient hospital – psychiatric
    • In-Network: $175 per day for days 1 through 10
      $0 per day for days 11 through 90 (Authorization Required)
    • Out-of-Network: 20% per stay (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: $25 copay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $25 copay (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • Out-of-Network: 20% coinsurance per visit (Authorization Required)
    • In-Network: $0-175 copay per visit (Authorization Required)

Preventive care

    • In-Network: $0 copay

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • In-Network: $20 copay (Authorization Required)
  • Occupational therapy visit
    • Out-of-Network: 20% coinsurance (Authorization Required)
    • In-Network: $20 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: 20% coinsurance (Authorization Required)

Skilled Nursing Facility

    • In-Network: $0 per day for days 1 through 20
      $178 per day for days 21 through 100 (Authorization Required)
    • Out-of-Network: 20% per stay (Authorization Required)

Transportation

    • Not covered

Vision

  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Not covered
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Upgrades
    • Not covered
  • Eyeglass frames
    • Not covered
  • Other
    • Not covered
  • Routine eye exam
    • In-Network: $20 copay (Limits Apply)

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

    • Covered

Ready to sign up for Ochsner Health Plan Heroes (HMO-POS) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

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