2016 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | HealthPartners Freedom Vital (Cost) | ||||
Location: | Lyon, Minnesota Click to see other locations | ||||
Plan ID: | H2462 - 018 - 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 |
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Email a copy of the HealthPartners Freedom Vital (Cost) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $38.90 (see Plan Premium Details below) | ||||
Annual Rx Deductible: | no drug coverage | ||||
Health Plan Type: | Cost * | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $3,400 | ||||
Number of Members enrolled in this plan in Lyon, Minnesota: | less than 10 members | ||||
Number of Members enrolled in this plan in Minnesota: | 808 members | ||||
Number of Members enrolled in this plan in (H2462 - 018): | 1,079 members | ||||
Plan’s Summary Star Rating: | 5 out of 5 Stars. This plan qualifies for the 5-star rating Special Enrollment period. Read more. | ||||
• Customer Service Rating: | Insufficient data to rate this plan. | ||||
• Member Experience Rating: | 5 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 4 out of 5 Stars. | ||||
— 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 ** | |||||
Monthly premium, deductible, and limits on how much you pay for covered services | |||||
$38.90 per month. In addition you must keep paying your Medicare Part B premium. | |||||
This plan does not have a deductible. | |||||
Yes. Our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care. | |||||
Your yearly limit(s) in this plan: | |||||
| |||||
If you reach the limit on out-of-pocket costs you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year. Please note that you will still need to pay your monthly premiums. | |||||
No. There are no limits on how much our plan will pay. | |||||
** Doctor and Hospital Choice ** | |||||
Acupuncture | |||||
$35 copay | |||||
** Extra Benefits ** | |||||
Inpatient mental health care | |||||
For inpatient mental health care see the "Mental Health Care" section. | |||||
Outpatient prescription drugs | |||||
For Part B drugs such as chemotherapy drugs1: 0-20% of the cost depending on the drug | |||||
Other Part B drugs1: 0-20% of the cost depending on the drug | |||||
Our plan does not cover Part D prescription drug. | |||||
** Important Information ** | |||||
Monthly premium, deductible, and limits on how much you pay for covered services | |||||
$38.90 per month. In addition you must keep paying your Medicare Part B premium. | |||||
This plan does not have a deductible. | |||||
Yes. Our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care. | |||||
Your yearly limit(s) in this plan: | |||||
| |||||
If you reach the limit on out-of-pocket costs you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year. Please note that you will still need to pay your monthly premiums. | |||||
No. There are no limits on how much our plan will pay. | |||||
** Outpatient Care and Services ** | |||||
Acupuncture | |||||
$35 copay | |||||
Ambulance | |||||
20% of the cost | |||||
Chiropractic care | |||||
Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position): $15 copay | |||||
Dental services | |||||
Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth): You pay nothing | |||||
Diabetes supplies and services | |||||
Diabetes monitoring supplies: 20% of the cost | |||||
Diabetes self-management training: You pay nothing | |||||
Therapeutic shoes or inserts: 20% of the cost | |||||
Diagnostic tests, lab and radiology services, and x-rays (Costs for these services may be different if received in an outpatient surgery setting) | |||||
Diagnostic radiology services (such as MRIs CT scans): 20% of the cost | |||||
Diagnostic tests and procedures: You pay nothing | |||||
Lab services: You pay nothing | |||||
Outpatient x-rays: 10% of the cost | |||||
Therapeutic radiology services (such as radiation treatment for cancer): 10% of the cost | |||||
Doctor's office visits | |||||
Primary care physician visit: $15 copay | |||||
Specialist visit: $40 copay | |||||
Durable medical equipment (wheelchairs, oxygen, etc.) | |||||
20% of the cost | |||||
Emergency care | |||||
$75 copay | |||||
If you are admitted to the hospital within 24 hours you do not have to pay your share of the cost for emergency care. See the "Inpatient Hospital Care" section for other costs. | |||||
Foot care (podiatry services) | |||||
Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions: $40 copay | |||||
Hearing services | |||||
Exam to diagnose and treat hearing and balance issues: $40 copay | |||||
Routine hearing exam (for up to 1 every year): You pay nothing | |||||
Home health care | |||||
You pay nothing | |||||
Mental health care | |||||
Inpatient visit: | |||||
The copays for hospital and skilled nursing facility (SNF) benefits are based on benefit periods. A benefit period begins the day you're admitted as an inpatient and ends when you haven't received any inpatient care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a SNF after one benefit period has ended a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There's no limit to the number of benefit periods. | |||||
Our plan covers an unlimited number of days for an inpatient hospital stay. | |||||
Outpatient group therapy visit: $20 copay | |||||
Outpatient individual therapy visit: $40 copay | |||||
Outpatient rehabilitation | |||||
Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks): You pay nothing | |||||
Occupational therapy visit: $40 copay | |||||
Physical therapy and speech and language therapy visit: $40 copay | |||||
Outpatient substance abuse | |||||
Group therapy visit: $40 copay | |||||
Individual therapy visit: $40 copay | |||||
Outpatient surgery | |||||
Ambulatory surgical center: $150 copay | |||||
Outpatient hospital: $0-150 copay depending on the service | |||||
Over-the-counter items | |||||
Not Covered | |||||
Prosthetic devices (braces, artificial limbs, etc.) | |||||
Prosthetic devices: 20% of the cost | |||||
Related medical supplies: 20% of the cost | |||||
Renal dialysis | |||||
You pay nothing | |||||
Transportation | |||||
Not covered | |||||
Urgently needed services | |||||
$40 copay | |||||
Vision services | |||||
Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening): $0-40 copay depending on the service | |||||
Routine eye exam (for up to 1 every year): You pay nothing | |||||
Eyeglasses or contact lenses after cataract surgery: You pay nothing | |||||
** Hospice ** | |||||
Hospice | |||||
You pay nothing for hospice care from a Medicare-certified hospice. You may have to pay part of the cost for drugs and respite care. | |||||
** Preventive Care ** | |||||
Preventive care | |||||
You pay nothing | |||||
Our plan covers many preventive services including:
| |||||
** Inpatient Care ** | |||||
Inpatient hospital care | |||||
The copays for hospital and skilled nursing facility (SNF) benefits are based on benefit periods. A benefit period begins the day you're admitted as an inpatient and ends when you haven't received any inpatient care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a SNF after one benefit period has ended a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There's no limit to the number of benefit periods. | |||||
Our plan covers an unlimited number of days for an inpatient hospital stay. | |||||
Inpatient mental health care | |||||
For inpatient mental health care see the "Mental Health Care" section. | |||||
Skilled Nursing Facility (SNF) | |||||
Our plan covers up to 100 days in a SNF. | |||||
Outpatient prescription drugs | |||||
For Part B drugs such as chemotherapy drugs1: 0-20% of the cost depending on the drug | |||||
Other Part B drugs1: 0-20% of the cost depending on the drug | |||||
Our plan does not cover Part D prescription drug. | |||||
** Outpatient Care ** | |||||
Diabetes supplies and services | |||||
Diabetes monitoring supplies: 20% of the cost | |||||
Diabetes self-management training: You pay nothing | |||||
Therapeutic shoes or inserts: 20% of the cost | |||||
Foot care (podiatry services) | |||||
Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions: $40 copay | |||||
Hearing services | |||||
Exam to diagnose and treat hearing and balance issues: $40 copay | |||||
Routine hearing exam (for up to 1 every year): You pay nothing | |||||
** Outpatient Medical Services and Supplies ** | |||||
Outpatient substance abuse | |||||
Group therapy visit: $40 copay | |||||
Individual therapy visit: $40 copay | |||||
Prosthetic devices (braces, artificial limbs, etc.) | |||||
Prosthetic devices: 20% of the cost | |||||
Related medical supplies: 20% of the cost | |||||
** Additional Benefits ** | |||||
Inpatient mental health care | |||||
For inpatient mental health care see the "Mental Health Care" section. | |||||
** Cost ** | |||||
Monthly premium, deductible, and limits on how much you pay for covered services | |||||
Package 1: Freedom Comprehensive Dental Benefit | |||||
Benefits include:
| |||||
Additional $39.90 per month. You must keep paying your Medicare Part B premium and your $38.90 monthly plan premium. | |||||
$50 per year. | |||||
Our plan pays up to $1 100 every year. | |||||
** Important Information ** | |||||
Package 1: Freedom Comprehensive Dental Benefit | |||||
Benefits include:
| |||||
Additional $39.90 per month. You must keep paying your Medicare Part B premium and your $38.90 monthly plan premium. | |||||
$50 per year. | |||||
Our plan pays up to $1 100 every year. |