Liberty Medicare Dual Plan (HMO D-SNP) is a Dual Special Needs Plan for individuals who are entitled to both Medicare and medical assistance from North Carolina Medicaid.
Liberty Medicare Dual Plan D-SNP
Benefit Highlights
2022 D-SNP Benefit Highlights
How much is the monthly premium?
$35.80 per month. You also must keep paying your Medicare Part B premium.
How much is the deductible?
$0 per year for in-network services.
$0 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 $7,550.
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.
Is there a limit on how much the plan will pay?
The plan does have a yearly coverage limit for certain in-network benefits. Please contact us for more information.
Enrollment Period
The Open Enrollment for Institutionalized Individuals (OEPI) is continuous for eligible individuals. You may enroll in Liberty Advantage at any time if you are eligible.
Eligibility Requirements
You can join Liberty Advantage if you have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), reside in or are expected to reside in a participating Liberty Advantage facility for 90 days or longer, and meet Liberty Advantage’s eligibility requirements.
Service Area:
- Alamance
- Bladen
- Buncombe
- Chatham
- Cumberland
- Forsyth
- Guilford
- Hyde
- Lee
- New Hanover
- Person
- Rowan
- Scotland
- Watauga
- Warren
- Yadkin
- Bertie
- Brunswick
- Catawba
- Columbus
- Davie
- Franklin
- Halifax
- Johnston
- Orange County
- Robeson
- Sampson
- Wake
Participating Nursing Facilities:
- Bermuda Commons Nursing & Rehabilitation Center
- Capital Nursing & Rehabilitation Center
- Liberty Commons Nursing & Rehabilitation Center of Columbus County
- Liberty Commons Nursing & Rehabilitation Center
- 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
- The Oaks
- 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
- Commons at Brightmore
- Warren Hills Rehabilitation & Nursing Center
- Bradley Creek Health Center at Carolina Bay
- 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
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 Advantage Representative, or click to download an Enrollment Form below and mail it to us at PO Box 3630, Little Rock, AR 72202.
Documents
- Enrollment Form
- Evidence of Coverage
- Pre-Enrollment Checklist
- Summary of Benefits
- Comprehensive Formulary
- Pharmacy Prior Authorization
- Step Therapy Criteria
- Pharmacy Directory
- Request for Redetermination of Medicare Prescription Drug Denial
- Request for Prescription Drug Coverage Determination
- Medication Therapy Management Program
- Prescription Drug Transition Policy
Safe Disposal
You can search for Drug Take Back programs near you: https://scdhec.gov/household-medicinepharmaceutical-disposal