1. Healthcare

HEALTHPARTNERS® FREEDOM
2015 PLAN COMPARISON GUIDE
H2462_82441 Accepted 9/14/2014 MNPlanComp
HEALTHPARTNERS® FREEDOM PLAN
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952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156
GETTING STARTED
TABLE OF CONTENTS
WHY CHOOSE HEALTHPARTNERS..........................................................................4
2015 QUICK REFERENCE: FREEDOM PLANS......................................................... 5
PLAN FEATURES .......................................................................................................... 6-7
NETWORK ......................................................................................................................... 8
HOW TO ENROLL .......................................................................................................... 9
MEDICARE OVERVIEW.......................................................................................... 10-11
FREEDOM PLAN OPTIONS CHART ................................................................. 12-27
CONTACT US ................................................................................................................. 28
MY NOTES ............................................................................................................... 29-30
healthpartners.com/medicare
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HEALTHPARTNERS® FREEDOM PLAN
WHY CHOOSE HEALTHPARTNERS?
THANK YOU FOR YOUR
INTEREST IN HEALTHPARTNERS®
FREEDOM (COST).
KEEP YOUR DOCTOR. With HealthPartners®
Freedom, you can choose from more than 38,000
doctors across Minnesota. We contract with
over 7,000 primary care and 29,000 specialty
providers, so you’re not limited to HealthPartners
Clinics.
COME TO A HEALTHPARTNERS COMMUNITY
MEETING. We regularly schedule gatherings in
your community so you can compare and consider
your options.
CALL US. Our representatives can answer
questions, walk you through enrollment and
provide additional information. Call 952-883-5601
or 800-247-7015, TTY 952-883-6060 or
800-443-0156. See page 28 for hours of operation.
BROWSE ONLINE.
Visit healthpartners.com/medicare, or
email us at [email protected].
For questions about your eligibility for Medicare
benefits or Original Medicare coverage, you can call
800-MEDICARE or visit medicare.gov. Phone lines
are open 24 hours a day, seven days a week. TTY
users can call 877-486-2048.
WE LOOK FORWARD TO BEING YOUR PARTNER IN GOOD HEALTH!
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952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156
GETTING STARTED
QUICK REFERENCE: 2015 FREEDOM PLAN COMPARISON
Freedom
Basic (Cost)
Freedom
Vital
with Rx
(Cost)
Freedom
Balance
with Rx
(Cost)
Freedom
Ultimate
with Rx
(Cost)
Freedom
Ultimate
with
Enhanced Rx
(Cost)
Monthly
premium*
Medical: $47
Drug: Not offered
Medical: $54
Drug: $10
Total: $64
Medical: $94
Drug: $24.80
Total: $118.80
Medical: $151
Drug: $39.70
Total: $190.70
Medical: $151
Drug: $196.10
Total: $347.10
Doctor
office visit
You pay 20%
of the cost.
You pay $15 per visit
for primary care and
$40 per visit for
specialty care.
You pay $15 per visit.
You pay $0 per visit.
virtuwell®
Unlimited visits to this 24/7 online clinic.
Preventive
care
100% coverage.
Inpatient
hospital
You pay $600
per benefit period.
You pay $300 per
benefit period.
You pay $200 per
benefit period.
Emergency
care (in U.S.)
You pay
$100 per visit.
You pay $75 per visit.
You pay $65 per visit.
Travel
coverage
You pay $100 per benefit period.
You pay $50 per visit.
Coverage for up to 9 months within U.S.
Prescription drug (Part D) coverage**
Deductible
Initial
coverage
Not offered.
Tiers 1-4: $175;
Tier 5: none
Not offered.
Tier 1: $5; Tier 2: $20;
Tier 3: $45; Tier 4:
$95; Tier 5: 33%
Coverage gap
Not offered.
Catastrophic
coverage
Not offered.
Tiers 1-4: $125;
Tier 5: none
Tiers 1-4: $160;
Tier 5: none
Tier 1: $5; Tier 2: $15; Tier 3: $45;
Tier 4: $95; Tier 5: 33%
Tiers 1-4: $100;
Tier 5: none
Tier 1: $5; Tier 2: $12;
Tier 3: $40; Tier 4:
$65; Tier 5: 33%
Tier 1: $5; Tier 2: $12;
Tier 3: 40%*** and
costs are further
reduced by 50%
You pay 65% for generics and
45% for brand drugs.
You pay 5% or $2.65 for generics and 5% or
$6.60 for all brand drugs, whichever is greater.
*You must continue to pay your Medicare Part B premium.
**In-network pharmacies
***Retail pharmacies and mail-order pharmacies with preferred cost-sharing. You pay 45% of the costs at mail-order pharmacies with
standard cost-sharing and costs are further reduced by 50%.
healthpartners.com/medicare
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HEALTHPARTNERS® FREEDOM PLAN
ADDITIONAL PLAN FEATURES
VIRTUWELL® — SICK. CLICK. CURED.
virtuwell is a simple, convenient online clinic that
treats everyday medical conditions – such as colds,
coughs, ear pain, flu or urinary tract infections –
from your home. You have 24/7 online access to
nurse practitioners, available from any computer,
with no appointment necessary. After a quick
online interview, you’ll receive a personalized
diagnosis, a treatment plan and, if needed, a
prescription sent to the pharmacy of your choice.
SILVER&FIT® EXERCISE AND HEALTHY
AGING PROGRAM
Silver&Fit is a program designed for Medicare
beneficiaries to improve their health through
education and exercise. Members can choose from
membership at a participating fitness facility or a
Home Fitness Program. Visit silverandfit.com to
learn more and locate participating facilities.
The program includes:
• Membership at a participating fitness facility.
You only pay an annual $25 fee!
Sick. Click. Cured.
Freedom members get
unlimited visits!
• The Silver&Fit Home Fitness Program for
members who are unable to go to a fitness
facility or prefer to work out at home. Pay an
annual fee of $10 and choose up to two Home
Fitness kits each year.
• The Silver Slate®, a quarterly newsletter.
New for 2015!
• Healthy Aging materials (online or DVD)
Unlimited Electronic visits (E-visit)
and Scheduled Telephone Visits.
To learn more, call
HealthPartners
Medicare Sales at
the numbers on
page 28.
• Silver&Fit Connected!™, a fun and easy way
to track your exercise at a facility, or through
a wearable fitness device or app and earn
rewards*
• A toll-free customer service hotline to answer
questions about the program.
Not all doctors and
clinics are set up to do
these visits. Check with
your provider for the
availability of this option.
Once you’re a HealthPartners® Freedom member,
enrolling in the Silver&Fit program is easy.
Visit silverandfit.com or call Silver&Fit Customer
Service at 877-427-4788 (TTY/TDD 877-710-2746)
to choose a participating facility near you and to
pay the annual fee by credit card or money order.
*Rewards subject to change; purchase of device or app is not included
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952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156
GETTING STARTED
TRAVEL WITH PEACE OF MIND
Activate your Extended Absence Benefit when
traveling outside of the Freedom service area.
Freedom members have coverage for up to nine
months each year within the United States, which
is perfect for snowbirds. Plus, on all plans except
Freedom Basic, members have worldwide coverage
for emergency and urgently needed care.
DENTAL COVERAGE
Coverage for one dental exam, one set of dental
X-rays and one dental cleaning is built into Freedom
Balance and Ultimate. If you want more coverage,
add the Freedom Comprehensive Dental benefit for
two preventive cleanings, plus coverage for fillings,
oral surgery, crowns, prosthetics and more.
PHARMACY TOOLS AND
MAIL ORDER PHARMACY
Managing your prescriptions can be expensive
and difficult. That’s why we offer several pharmacy
tools to help you save time and money!
• Drug Cost Calculator Find the pharmacy that
offers your medicines for the best price. Visit
healthpartners.com/pharmacy.
HEALTHY DISCOUNTS PROGRAM
Save money at local and national retailers when you
show your HealthPartners Member ID card. You
can save on eyewear, hearing aids, fitness classes,
healthy meals and more!
To view a list of all participating retailers, visit
healthpartners.com/discounts.
CARELINE SM SERVICE AND
HEALTHPARTNERS® NURSE
NAVIGATORS SM PROGRAM
You have free access to CareLine SM and Nurse
Navigators SM. CareLine is staffed 24 hours a
day with registered nurses who can answer your
health questions and discuss treatment options.
Nurse Navigators provide special help on coverage
questions to guide you through networks, benefits
and services
• Drug interaction checker Make sure your new
medication doesn’t interact improperly with
your current medications.
• myMailRx Get your prescriptions delivered
right to your door with HealthPartners
myMailRx*. Most HealthPartners members
get a three-month supply of their medicine for
just two copays! Typically, you can expect to
receive your prescription drugs within five to
seven business days from the time that the mail
order pharmacy receives the order.
Visit healthpartners.com/myMailRx
to learn more.
*Other pharmacies are available in our network.
healthpartners.com/medicare
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HEALTHPARTNERS® FREEDOM PLAN
HEALTHPARTNERS® FREEDOM
INTRODUCING HEALTHPARTNERS® FREEDOM
HealthPartners® Freedom offers benefits in addition to those provided by Original Medicare. Choose from
four medical plan options and pair with Part D prescription drug coverage to get the best value. Our Part D
coverage is available with Freedom Vital, Balance and Ultimate; Enhanced Part D coverage is available with
Freedom Ultimate.
Freedom is different from other types of Medicare plans because you’re not locked into a primary care clinic
or network. You can use your Medicare benefits outside of our network or service area at any time. Call
HealthPartners Medicare Sales for more information.
OUR NETWORK
With our large network of 38,000 providers, chances are your doctor is covered. Search for your provider
by visiting healthpartners.com/medicare, or give us a call and we can look it up for you.
Major clinic systems in our network include:
VOCABULARY
HealthPartners Medical Group
Park Nicollet Health Services
Fairview Health Services
University of Minnesota Physicians
North Memorial Health Care
HealthEast Care System
Essentia (Duluth)
St. Luke’s (Duluth)
Network: Doctors, hospitals, pharmacies and
other health care experts who have contracted with
your health plan. Plan members get the lowest cost
for services when using network providers.
Provider: Any organization, institution or
individual that supplies health care services.
Service area: The defined geographic region
where a health plan accepts members and where the
plan’s services are provided.
CentraCare (St. Cloud)
St. Cloud Medical Group
Other providers are
available in our network.
remember
Our network includes HealthPartners Clinics, and we’re
proud of the care they provide. But you can also choose to
receive care at hundreds of other network clinics.
This brochure talks about Minnesota Freedom plan options. We also have a service area in Wisconsin. If you’re
interested in Wisconsin Freedom plan options, please contact us.
Freedom
Service
Area
8
Includes all of Minnesota
and eight Western
Wisconsin counties.
952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156
GETTING STARTED
HOW TO ENROLL
STEP 1: PICK YOUR PLAN
Choose the medical plan option that fits you best.
Then decide what you want to add on, if anything,
such as affordable prescription drug or dental
coverage.
STEP 2: ENROLL
Enrolling in HealthPartners® Freedom is easy.
To enroll, you can:
Completed enrollment forms that are received
by HealthPartners by the last day of the month
are generally effective for the first day of the next
calendar month. For example, a form received on
January 31 would be effective February 1.
After you’ve enrolled, you’ll receive a packet from
us containing your member ID card, Evidence of
Coverage, network directories, drug formulary and
several other items. If you have questions prior to
that, just call us!
Go online to healthpartners.com/medicare
and click “Compare & enroll”
Call us at 952-883-7788 or 877-240-8311
Fill out the paper application
•
You can mail it to us using the prepaid
envelope in this folder. Or, you can fax
it to us at 952-853-8746.
You’ll be asked for:
• Your contact information
• Your plan selection
• Your Medicare number and Part A and/or B
enrollment dates
• Your payment/billing preference
Eligibility
To enroll in Freedom, you must:
• Be entitled to Medicare Part A and
enrolled in Medicare Part B, or
enrolled in Part B only
• Live in Minnesota
• Not have end-stage renal disease
(ESRD)*
*Some exceptions apply.
Call HealthPartners Medicare Sales
at the numbers on page 28.
• Answers to questions that help determine your
eligibility and enrollment status
• Your signature or the signature of your
authorized representative
healthpartners.com/medicare
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HEALTHPARTNERS® FREEDOM PLAN
MEDICARE OVERVIEW
Medicare is divided into “Parts”:
• Part A is hospital insurance, covering inpatient
hospital care including care in skilled nursing
facilities, hospice and some home health care.
• Part B is medical insurance, covering doctor’s
services and outpatient care.
• Part D is prescription drug insurance. It’s
only available from private health insurance
companies.
If you’re already getting benefits from Social Security
or Railroad Retirement Board, you automatically get
Original Medicare (Parts A and B) when you turn 65
years old.
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WHAT ISN’T COVERED UNDER
ORIGINAL MEDICARE?
Many people decide to buy additional coverage
because there are things Original Medicare does
not cover:
• Deductibles, coinsurance and copayments for
covered services
• Most prescription drugs
• Health care services outside of the United States
• Most dental care
• Routine hearing exams
• Routine eye care
• Acupuncture
Certain private health plans may cover some or all
of the services listed above.
V O C A B U L A R Y
Medicare is a federal health insurance program for
people who are 65 or older, people with certain
disabilities and people of all ages with end-stage
renal disease (permanent kidney failure requiring
dialysis or a transplant, sometimes called ESRD).
You cannot be denied coverage due to pre-existing
conditions and your coverage cannot be cancelled if
you get sick.
Copay or Copayment: What you pay
when you use a medical service or drug;
usually a flat dollar amount like $15.
Coinsurance: The percentage of the total
bill you pay when you use a medical service
or drug.
Creditable Coverage: Prescription
drug coverage that is equal to or better than
standard Medicare Part D.
Deductible: What you pay for a service
item or drug before your insurance kicks in.
952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156
MEDICARE BASICS
ENROLLMENT PERIODS
You can enroll in a Cost plan, like HealthPartners® Freedom, any time. However, there may be limitations
if you’re currently enrolled in another Medicare plan or a Cost plan with prescription drug coverage. Visit
medicare.gov for more information.
1. The Annual Election Period (AEP) runs from October 15 to December 7. During the AEP:
• All Medicare-eligible individuals can make changes to medical and prescription drug coverage
• All enrollment and disenrollment options are available
• Changes are effective January 1 of the next year
2. The Part D Initial Enrollment Period (IEP) is the period in which you may enroll without penalty in a plan
with Part D prescription drug coverage. This period is from three months before to three months after
your 65th birthday month.
3. The Special Enrollment Period (SEP) is an enrollment period for special circumstances. Check with
HealthPartners or medicare.gov for specifics on rules and details.
Election/Enrollment period
When an eligible person can join or leave the
Original Medicare Cost Plan and/or a Medicare
plan, such as the Freedom plan.
Medicare Cost plan
A Cost plan lets you use benefits outside the plan’s network
or service area and covered services are paid for by Original
Medicare. The Freedom plan is a Medicare Cost plan.
healthpartners.com/medicare
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HEALTHPARTNERS® FREEDOM PLAN
FREEDOM PLAN OPTIONS
Use the benefit grids on the following pages to find out how most services are covered. Remember, if you
don’t see something you’re looking for, you can always call us.
Monthly
Premium*
Freedom Basic
Freedom Vital
Medical Plan Only
$47
$54
Rx (Part D)
Not offered
$10
Enhanced Rx (Part D)
Not offered
Not offered
Medical and
Rx Combined
Not offered
$64
Out-of-pocket
Maximum
Not offered
$3,000
*You must continue to pay your Medicare Part B premium.
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952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156
PLAN DETAILS
Freedom Balance
Freedom Ultimate
$94
$151
$24.80
$39.70
Not offered
$196.10
$118.80
$190.70 with Rx
$347.10 with Enhanced Rx
$3,000
$3,000
Premium
What you pay each
month for your health or
prescription drug plan.
healthpartners.com/medicare
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HEALTHPARTNERS® FREEDOM PLAN
Benefit
Category
Freedom Basic
Freedom Vital
Your Cost
Your Cost
Preventive Care and Wellness/Education Programs*
Preventive Care**
$0 (100% coverage)
$0 (100% coverage)
Wellness/ Education
Programs
You pay $0 for:
You pay $0 for:
- Nursing hotline
- Additional smoking cessation
- Nursing hotline
You pay an annual $25 or $10 fee for Silver&Fit®
Preventive Dental Care
Not covered
Not covered, but you can select optional
preventive and comprehensive dental coverage.
See pages 26-27.
Out of State Within
the U.S. (Extended
Absence Benefit)
Call Member Services to activate!
Call Member Services to activate!
You can travel for up to nine months in the U.S.
with the same level of coverage as in-network.
See Medicare participating doctors and present
both your Medicare and HealthPartners
membership card.
You can travel for up to nine months in the U.S.
with the same level of coverage as in-network.
See Medicare participating doctors and present
both your Medicare and HealthPartners
membership card.
Out of the U.S.
Not covered.
Worldwide coverage for urgent or emergency
care. You pay 20% of the cost.
Travel Benefit
We’ve got you covered!
**Preventive care includes abdominal aortic aneurysm screening, alcohol misuse counseling, bone mass measurement,
breast cancer screening (mammogram), cardiovascular disease (behavioral therapy), cardiovascular screenings, cervical
and vaginal cancer screening, colonoscopy, colorectal cancer screenings, depression screening, diabetes screenings,
fecal occult blood test, flexible sigmoidoscopy, HIV screening, medical nutrition therapy services, obesity screening
and counseling, prostate cancer screenings (PSA), sexually transmitted infections screening and counseling, tobacco
use cessation counseling (counseling for people with no sign of tobacco-related disease), vaccines, including Flu shots,
Hepatitis B shots, Pneumococcal shots ,”Welcome to Medicare” preventive visit (one-time) and a yearly “Wellness” visit.
* In-network providers
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952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156
PLAN DETAILS
Freedom Balance
Freedom Ultimate
Your Cost
Your Cost
$0 (100% coverage)
$0 (100% coverage)
You pay $0 for:
You pay $0 for:
- Additional smoking cessation
- Additional smoking cessation
- Nursing hotline
- Nursing hotline
You pay an annual $25 or $10 fee for Silver&Fit®
You pay an annual $25 or $10 fee for Silver&Fit®
You pay $0 for:
You pay $0 for:
- 1 preventive exam
- 1 preventive exam
- 1 cleaning
- 1 cleaning
- 1 set of X-rays
- 1 set of X-rays
Comprehensive dental coverage is available.
See pages 26-27.
Comprehensive dental coverage is available.
See pages 26-27.
Call Member Services to activate!
Call Member Services to activate!
You can travel for up to nine months in the U.S. with the same
level of coverage as in-network. See Medicare participating
doctors and present both your Medicare and HealthPartners
membership card.
You can travel for up to nine months in the U.S. with the same
level of coverage as in-network. See Medicare participating
doctors and present both your Medicare and HealthPartners
membership card.
Worldwide coverage for urgent or emergency care. You pay 20%
of the cost.
Worldwide coverage for urgent or emergency care. You pay 20%
of the cost.
healthpartners.com/medicare
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HEALTHPARTNERS® FREEDOM PLAN
Benefit
Category
Freedom Basic
Freedom Vital
Your Cost
Your Cost
Office Visit/Outpatient Services*
Primary Care Doctor/
Specialist/Convenience
Care
20% of the cost
Urgent Care
20% of the cost
$40 copay
Not covered outside the U.S.
20% of the cost outside the U.S.
You get unlimited access to and pay $0 for:
You get unlimited access to and pay $0 for:
- virtuwell®
- virtuwell®
- Electronic visits (E-visit)
- Electronic visits (E-visit)
- Scheduled Telephone Visits
- Scheduled Telephone Visits
$0 copay for lab services
$0 copay for lab services
20% of the cost for
- diagnostic procedures and tests
- diagnostic procedures and tests
10% of the cost for
- X-rays
- X-rays
- diagnostic radiology services (MRI, CT)
- therapeutic radiology services (cancer treatment)
- therapeutic radiology services (cancer treatment)
20% of the cost for diagnostic radiology services
(MRI, CT)
Outpatient
Mental Health
20% of the cost for individual or group therapy
visits.
$40 copay/individual therapy visit
Outpatient Substance
Abuse
20% of the cost
$40 copay
Acupuncture
Not covered
$35 copay
Chiropractic Services
20% of the cost
$15 copay
Podiatry Services
20% of the cost (medically necessary services)
$40 copay (medically necessary services)
Rehabilitation
Services**
20% of the cost
$40 copay
Cardiac and Pulmonary
Rehabilitation Services
20% of the cost
$0 copay
Web/Phone Based
Technologies
Diagnostic Tests,
X-Rays, Lab Services
and Radiology Services
$15 primary copay
$40 specialist copay
$20 copay/group therapy visit
* In-network providers
** Occupational and physical therapy, speech and language pathology
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952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156
PLAN DETAILS
Freedom Balance
Freedom Ultimate
Your Cost
Your Cost
$15 copay
$0 copay
$15 copay
$0 copay
20% of the cost outside the U.S.
20% of the cost outside the U.S.
You get unlimited access to and pay $0 for:
You get unlimited access to and pay $0 for:
- virtuwell®
- virtuwell®
- Electronic visits (E-visit)
- Electronic visits (E-visit)
- Scheduled Telephone Visits
- Scheduled Telephone Visits
$0 copay for
$0 copay for
- lab services
- lab services
- X-rays
- X-rays
- diagnostic procedures and tests
- diagnostic procedures and tests
- therapeutic radiology services (cancer treatment)
- therapeutic radiology services (cancer treatment)
20% of the cost for diagnostic radiology services (MRI, CT)
10% of the cost for diagnostic radiology services (MRI, CT)
$15 copay/individual therapy visit
$0 copay
$7.50 copay/group therapy visit
$15 copay
$0 copay
$15 copay
$0 copay
$15 copay
$0 copay
$15 copay (medically necessary services)
$0 copay (medically necessary services)
$15 copay
$0 copay
$0 copay
$0 copay
healthpartners.com/medicare
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HEALTHPARTNERS® FREEDOM PLAN
Benefit
Category
Freedom Basic
Freedom Vital
Your Cost
Your Cost
Hospital, Inpatient*
Inpatient Hospital
Care
(Includes Mental Health,
Substance Abuse and
Rehabilitation Services)
$600 copay for each benefit period
$300 copay for each benefit period
Plan covers 90 days each benefit period
$0 copay for additional non-Medicare-covered
hospital days
You get up to 190 days in a psychiatric hospital in
a lifetime
Plan covers 60 lifetime reserve days
Skilled Nursing Facility
(SNF)**
(In a Medicare-certified
skilled nursing facility)
No limit to the number of days covered by the
plan each benefit period
$0 copay per lifetime reserve stay
Contact the plan for details about coverage in a
psychiatric hospital beyond 190 days
Days 1-20 $0 copay per day
Days 1-20 $0 copay per day
Days 21-100 $130 copay per day
Days 21-100 $100 copay per day
Plan covers up to 100 days each benefit period
Plan covers up to 100 days each benefit period
* In-network providers
**Medically necessary intermittent skilled nursing care, home health aide services, rehabilitation services
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952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156
PLAN DETAILS
Freedom Balance
Freedom Ultimate
Your Cost
Your Cost
$200 copay for each benefit period
$100 copay for each benefit period
$0 copay for additional non-Medicare-covered hospital days
$0 copay for additional non-Medicare-covered hospital days
No limit to the number of days covered by the plan each benefit
period
No limit to the number of days covered by the plan each benefit
period
Contact the plan for details about coverage in a psychiatric
hospital beyond 190 days
Contact the plan for details about coverage in a psychiatric
hospital beyond 190 days
$0 copay
$0 copay
Plan covers up to 100 days each benefit period
Plan covers up to 100 days each benefit period
Benefit Period
Begins the day you’re admitted as an inpatient in a
hospital or SNF and ends when you haven’t received
inpatient hospital care (or skilled care in a SNF) for 60
days in a row.
healthpartners.com/medicare
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HEALTHPARTNERS® FREEDOM PLAN
Benefit
Category
Freedom Basic
Freedom Vital
Your Cost
Your Cost
Hospital, Outpatient Surgery*
Ambulatory Surgery
20% of the cost
$150 copay
Outpatient Hospital
20% of the cost
$0 copay
Outpatient Medical Services and Supplies*
Durable Medical
Equipment
20% of the cost
20% of the cost
Prosthetic Devices
20% of the cost
20% of the cost
Diabetes
Self-Monitoring
Training, Nutrition
Therapy
$0 copay
$0 copay
Diabetes Supplies
20% of the cost
20% of the cost
Kidney Disease and
Conditions
20% of the cost for renal dialysis
$0 copay
$0 copay for education services
$0 copay for education services
$0 copay
$0 copay
Other Services*
Home Health Care**
* In-network providers
** Medically necessary intermittent skilled nursing care, home health aide services, rehabilitation services
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952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156
PLAN DETAILS
Freedom Balance
Freedom Ultimate
Your Cost
Your Cost
$100 copay
$50 copay
$0 copay
$0 copay
20% of the cost
20% of the cost
20% of the cost
20% of the cost
$0 copay
$0 copay
20% of the cost
20% of the cost
$0 copay
$0 copay
$0 copay for education services
$0 copay for education services
$0 copay
$0 copay
healthpartners.com/medicare
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HEALTHPARTNERS® FREEDOM PLAN
Freedom Basic
Freedom Vital
Your Cost
Your Cost
Ambulance Services
20% of the cost
20% of the cost
Emergency Room
Visit**
$100 copay in U.S.
$75 copay in U.S.
Not covered outside the U.S. except under limited
circumstances. Contact the plan for more details.
20% of the cost outside the U.S.
Benefit
Category
Emergency Services*
Hearing/Vision Services*
Annual Routine Check
Not covered
$0 copay
0% to 20% of the cost for annual glaucoma
screening
$0 to $40 copay for annual glaucoma screening
Diagnostic Exams
0% to 20% of the cost
$0 to $40 copay
Hearing Aids
Not covered. Discounts up to 30%.
Not covered. Discounts up to 30%.
Eye Glasses
$0 copay for one pair of eyeglasses (lenses and
frames) or contact lenses after cataract surgery
$0 copay for one pair of eyeglasses (lenses and
frames) or contact lenses after cataract surgery
Drugs Covered Under Medicare Part B*
20% of the cost
0%-20% of the cost
$0 copay for Part B injections in a physician’s
office
* In-network providers
** If you are admitted to the hospital within 24-hours for the same condition, you pay $0 for the emergency
room visit.
22
952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156
PLAN DETAILS
Freedom Balance
Freedom Ultimate
Your Cost
Your Cost
10% of the cost
$0 copay
$65 copay in U.S.
$50 copay in U.S.
20% of the cost outside the U.S.
20% of the cost outside the U.S.
$0 copay
$0 copay
$0 to $15 copay for annual glaucoma screening
$0 copay for annual glaucoma screening
$0 to $15 copay
$0 copay
Not covered. Discounts up to 30%.
Not covered. Discounts up to 30%.
$0 copay for one pair of eyeglasses (lenses and frames) or
contact lenses after cataract surgery
$0 copay for one pair of eyeglasses (lenses and frames) or
contact lenses after cataract surgery
0%-20% of the cost
0%-20% of the cost
$0 copay for Part B injections in a physician’s office
$0 copay for Part B injections in a physician’s office
healthpartners.com/medicare
23
HEALTHPARTNERS® FREEDOM PLAN
OPTIONAL PRESCRIPTION DRUG COVERAGE
Benefit Category
Freedom
Basic
Your
Cost
Freedom Vital with Rx
Freedom Balance
with Rx
Your Cost
Your Cost
Prescription Drug Coverage Under Medicare Part D*
Monthly Premium **
Not offered
(Medical + Rx = Total)
$54 + $10
$94 + $24.80
Total: $64
Total: $118.80
Deductible
Not offered
Tiers 1-4: $175; Tier 5: none
Tiers 1-4: $125; Tier 5: none
Initial Coverage
Not offered
Tier 1: $5; Tier 2: $20; Tier 3: $45; Tier
4: $95; Tier 5: 33%
Tier 1: $5; Tier 2: $15; Tier 3: $45; Tier 4:
$95; Tier 5: 33%
Not offered
You pay 65% for generics and 45% for
brand drugs.
You pay 65% for generics and 45% for
brand drugs.
Not offered
You pay 5% or $2.65 for generics
and 5% or $6.60 for all brand drugs,
whichever is greater.
You pay 5% or $2.65 for generics
and 5% or $6.60 for all brand drugs,
whichever is greater.
(until you and the plan
pay $2,960)
Coverage Gap
(after you and the plan
pay $2,960)
Catastrophic Coverage
(after only you pay $4,700)
* In-network pharmacies
**You must continue to pay your Medicare Part B premium.
Call HealthPartners Medicare Sales at the numbers on page 28 for more details. Save on your prescriptions!
$ Preferred Generic Drugs
$$ Non-preferred Generic Drugs
$$$ Preferred Brand Drugs
$$$$ Non-preferred Brand Drugs
$$$$$ Specialty Drugs
24
Drug Tier: A system of copays or
coinsurance for the different kinds of
prescription drugs. Generally, a drug in a lower
tier will cost you less than a drug in a higher tier.
Specialty drugs: Very high-cost and
used to treat rare conditions.
952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156
PLAN DETAILS
Freedom Ultimate with Rx
Freedom Ultimate with Enhanced Rx
Your Cost
Your Cost
$151 + $39.70
$151 + $196.10
Total: $190.70
Total: $347.10
Tiers 1-4: $160; Tier 5: none
Tiers 1-4: $100; Tier 5: none
Tier 1: $5; Tier 2: $15; Tier 3: $45; Tier 4: $95; Tier 5: 33%
Tier 1: $5; Tier 2: $12; Tier 3: $40; Tier 4: $65; Tier 5: 33%
You pay 65% for generics and 45% for brand drugs.
Tier 1: $5; Tier 2: $12; Tier 3: 40%*** and costs are further reduced
by 50%
You pay 5% or $2.65 for generics and 5% or $6.60 for all brand
drugs, whichever is greater.
You pay 5% or $2.65 for generics and 5% or $6.60 for all brand
drugs, whichever is greater.
*** Retail and mail order pharmacies with preferred cost-sharing. You pay 45% of the costs at mail order
pharmacies with standard cost-sharing and costs are further reduced by 50%.
Formulary
A list of drugs that are covered by your plan.
WANT TO SEE IF YOUR DRUG IS ON OUR FORMULARY?
Visit healthpartners.com/medicarerx or give us a call.
healthpartners.com/medicare
25
HEALTHPARTNERS® FREEDOM PLAN
OPTIONAL DENTAL COVERAGE
Enroll when you’re first eligible or between October 15 and December 31.
Freedom Basic
Freedom Vital
Your Cost
Your Cost
Not offered
$39.90
Benefit Category
Dental Coverage *
Monthly Premium
Preventive and Diagnostic Care Not offered
$0 (100% coverage)
- Routine examinations, cleanings
and X-rays
Sealants
Not offered
50% of the cost
Not offered
50% of the cost
Not offered
50% of the cost
Not offered
50% of the cost
Not offered
$50
- Pit and fissure sealants
Regular and Restorative Care
- Fillings and oral surgery
- Periodontics and endodontics
Special Restorative Care
- Restorative crowns and onlays
Prosthetics
- Bridges
- Dental Implants
(up to $500 per calendar year)
- Dentures and partial dentures
Annual Deductible
-For regular and restorative care,
special restorative care and
prosthetics
Annual Maximum Benefit
$0 for preventive and diagnostic services
Not offered
$1,100**
Preventive and diagnostic services do apply to
the annual maximum.
*In-network
**For out-of-network services in the service area, the maximum benefit is $200 and subject to the $1,100 maximum benefit
26
952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156
PLAN DETAILS
Freedom Balance
Freedom Ultimate
Your Cost
Your Cost
$39.90
$39.90
$0 (100% coverage)
$0 (100% coverage)
50% of the cost
50% of the cost
50% of the cost
50% of the cost
50% of the cost
50% of the cost
50% of the cost
50% of the cost
$50
$50
$0 for preventive and diagnostic services
$0 for preventive and diagnostic services
$1,100**
$1,100**
Preventive and diagnostic services do not apply to the annual
maximum.
Preventive and diagnostic services do not apply to the annual
maximum.
healthpartners.com/medicare
27
HEALTHPARTNERS® FREEDOM PLAN
CONTACT US
At any time during your research and enrollment
process, knowledgeable HealthPartners
representatives are standing by to help answer your
questions.
Other helpful resources for
Medicare decision-making:
CALL MEDICARE SALES:
medicare.gov
952-883-5601 or 800-247-7015
800-MEDICARE
TTY 952-883-6060 or 800-443-0156
24 hours a day, seven days a week
From October 1 through February 14, we take calls
from 8 a.m. to 8 p.m., seven days a week. You’ll
speak with a representative.
SOCIAL SECURITY ADMINISTRATION
From February 15 to September 30, call us 8 a.m.
to 8 p.m. Monday through Friday to speak with a
representative. On Saturdays, Sundays and Federal
holidays, you can leave a message and we’ll get
back to you within one business day.
EMAIL:
MEDICARE
ssa.gov/pgm/medicare.htm
800-772-1213
7 a.m. to 7 p.m.
Monday through Friday
SENIOR LINKAGE LINE®
mnaging.org/advisor/SLL
[email protected]
800-333-2433
GO ONLINE:
8 a.m. to 4:30 p.m.
Monday through Friday
healthpartners.com/medicare
STOP BY:
HealthPartners Medicare Sales
8170 33rd Ave S
Bloomington, MN 55425
You can also attend one of our community
meetings. Call or go online to find and register for
the next one in your area!
28
952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156
ENROLL NOW
Questions to ask
When researching your options, here are good
questions for any plan you are considering:
•
Can I keep my doctor?
•
Do I need referrals to see specialists?
•
Are my medicines covered?
•
What options do I have if I need to change my
level of coverage in the future?
•
Is there coverage if I plan to travel?
NOTES
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healthpartners.com/medicare
29
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952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156
HealthPartners is a Cost plan with a Medicare contract. Enrollment in HealthPartners depends on
contract renewal.
If you attend a community meeting, a sales person will be present with information and applications. For
accommodations of persons with special needs at sales meetings, call HealthPartners Medicare Sales at the
numbers on page 28.
The benefit information provided is a brief summary, not a complete description of benefits. For more
information contact the plan. Limitations, copayments and restrictions may apply. Benefits, formulary,
pharmacy network, provider network, premium and copayments/coinsurance may change on January 1
of each year.
You must continue to pay your Medicare Part B premium.
The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American
Specialty Health Incorporated (ASH). All programs and services are not available in all areas. Silver&Fit,
Silver&Fit Connected!, the Silver&Fit logo, and The Silver Slate are federally registered trademarks of ASH and
used with permission herein.
8170 33rd Ave S
Bloomington MN, 55425
3549 (8/14) ©2014 HealthPartners