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2011 Medicare Advantage Plan Benefit Details for the HealthPartners Freedom Plan I (Cost) - H2462-004-0
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2011 Medicare Advantage Plan Details
Medicare Plan Name:HealthPartners Freedom Plan I (Cost)
Location:Anoka, Minnesota     Click to see other locations
Plan ID:H2462 - 004 - 0     Click to see other plans
Member Services:1-800-233-9645 TTY users 1-800-443-0156
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
Medicare Contact Information:Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.
TTY users 1-877-486-2048
or contact your local SHIP for assistance
Email a copy of the HealthPartners Freedom Plan I (Cost) benefit details
— Medicare Plan Features —
Monthly Premium:$61.00 (see Plan Premium Details below)
Annual Deductible:no drug coverage
Health Plan Type:Cost *
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$-1
Number of Members enrolled in this plan in (H2462 - 004):4,519 members
— Plan Premium Details —
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔100%
Subsidy		75%
Subsidy		50%
Subsidy		25%
Subsidy
Monthly Part D Premium with LIS:$0.00$0.00$0.00$0.00
— Plan Health Benefits —
** Cost **
Premium and Other Important Information
$61.00 monthly plan premium in addition to your monthly Medicare Part B premium.
Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
This plan covers all Medicare-covered preventive services with zero cost sharing.
** Doctor and Hospital Choice **
Doctor and Hospital Choice
No referral required for network doctors specialists and hospitals.
You can use any network doctor. If you go to out-of-network doctors the plan may not cover the services but Medicare will pay its share for Medicare-covered services. When Medicare pays its share you pay the Medicare Part B deductible and coinsurance.
Plan covers you when you travel in the U.S.
** Extra Benefits **
Prescription Drugs
Most drugs not covered.
20% of the cost for Part B-covered chemotherapy drugs and other Part B-covered drugs.
This plan does not offer prescription drug coverage.
Physical Exams
When you get Medicare Part B you can get a one-time physical within the first 12 months of your new Part B coverage. The coverage does not include lab tests.
Vision Services
Non-Medicare-covered eye exams and glasses not covered.
$0 copay for
  • one pair of eyeglasses or contact lenses after cataract surgery
  • 0% to 20% of the cost for exams to diagnose and treat diseases and conditions of the eye.
    • Dental Services
    In general preventive dental benefits (such as cleaning) not covered.
    20% of the cost for Medicare-covered dental benefits.
    ** Important Information **
    Premium and Other Important Information
    $61.00 monthly plan premium in addition to your monthly Medicare Part B premium.
    Most people will pay the standard monthly Part B premium in addition to their MA plan premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
    This plan covers all Medicare-covered preventive services with zero cost sharing.
    Doctor and Hospital Choice
    No referral required for network doctors specialists and hospitals.
    You can use any network doctor. If you go to out-of-network doctors the plan may not cover the services but Medicare will pay its share for Medicare-covered services. When Medicare pays its share you pay the Medicare Part B deductible and coinsurance.
    Plan covers you when you travel in the U.S.
    ** Inpatient Care **
    Inpatient Hospital Care (Acute)
    Plan covers 90 days each benefit period.
    $300 copay for each Medicare-covered hospital stay
    Inpatient Mental Health Care
    You get up to 190 days in a Psychiatric Hospital in a lifetime.
    $300 copay for each Medicare-covered hospital stay.
    Skilled Nursing Facility (SNF)
    Plan covers up to 100 days each benefit period
    $0 copay for SNF services
    Home Health Care
    $0 copay for Medicare-covered home health visits.
    Hospice
    You must get care from a Medicare-certified hospice.
    ** Outpatient Care **
    Doctor Office Visits
    20% of the cost for each primary care doctor visit for Medicare-covered benefits.
    20% of the cost for each in-area network urgent care Medicare-covered visit.
    20% of the cost for each specialist visit for Medicare-covered benefits.
    Chiropractic Services
    20% of the cost for each Medicare-covered visit.
    Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers.
    Podiatry Services
    20% of the cost for each Medicare-covered visit.
    Medicare-covered podiatry benefits are for medically-necessary foot care.
    Outpatient Mental Health Care
    20% of the cost for each Medicare-covered individual or group therapy visit.
    Outpatient Substance Abuse Care
    20% of the cost for Medicare-covered individual or group visits.
    Outpatient Hospital Services
    20% of the cost for each Medicare-covered ambulatory surgical center visit.
    20% of the cost for each Medicare-covered outpatient hospital facility visit.
    Emergency Care
    $50 copay for Medicare-covered emergency room visits.
    Not covered outside the U.S. except under limited circumstances. Contact the plan for more details.
    If you are admitted to the hospital within 24-hour(s) for the same condition you pay $0 for the emergency room visit
    Outpatient Rehabilitation Services
    20% of the cost for Medicare-covered Occupational Therapy visits.
    20% of the cost for Medicare-covered Physical and/or Speech and Language Therapy visits.
    20% of the cost for Medicare-covered Cardiac Rehab services.
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    20% of the cost for Medicare-covered items.
    Prosthetic Devices
    20% of the cost for Medicare-covered items.
    Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies
    $0 copay for Diabetes self-monitoring training.
    $0 copay for Nutrition Therapy for Diabetes.
    20% of the cost for Diabetes supplies.
    ** Preventive Services **
    Bone Mass Measurement
    $0 copay for Medicare-covered bone mass measurement
    Colorectal Screening Exams
    $0 copay for Medicare-covered colorectal screenings.
    Immunizations
    $0 copay for Flu and Pneumonia vaccines.
    $0 copay for Hepatitis B vaccine.
    No referral needed for Flu and pneumonia vaccines.
    Pap Smears and Pelvic Exams
    $0 copay for Medicare-covered pap smears and pelvic exams.
    Prostate Cancer Screening Exams
    $0 copay for
    • Medicare-covered prostate cancer screening
    ** Additional Benefits **
    Dialysis
    Cost plan members pay Fee-for-Service cost sharing for out-of-area dialysis.
    20% of the cost for renal dialysis
    $0 copay for Nutrition Therapy for End-Stage Renal Disease
    Prescription Drugs
    Most drugs not covered.
    20% of the cost for Part B-covered chemotherapy drugs and other Part B-covered drugs.
    This plan does not offer prescription drug coverage.
    Dental Services
    In general preventive dental benefits (such as cleaning) not covered.
    20% of the cost for Medicare-covered dental benefits.
    Hearing Services
    In general routine hearing exams and hearing aids not covered.
  • 20% of the cost for Medicare-covered diagnostic hearing exams
    • Vision Services
    Non-Medicare-covered eye exams and glasses not covered.
    $0 copay for
    • one pair of eyeglasses or contact lenses after cataract surgery
  • 0% to 20% of the cost for exams to diagnose and treat diseases and conditions of the eye.
    • Physical Exams
    When you get Medicare Part B you can get a one-time physical within the first 12 months of your new Part B coverage. The coverage does not include lab tests.
    Health/Wellness Education
    $0 copay for each Medicare-covered smoking cessation counseling session.
    $0 copay for each Medicare-covered HIV screening.
    HIV screening is covered for people with Medicare who are pregnant and people at increased risk for the infection including anyone who asks for the test. Medicare covers this test once every 12 months or up to three times during a pregnancy.
    Transportation
    This plan does not cover routine transportation.
    Acupuncture
    This plan does not cover Acupuncture.




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