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2016 Medicare Advantage Plan Benefit Details for the HealthPartners Freedom Ultimate (Cost) - H2462-010-0
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2016 Medicare Advantage Plan Details
Medicare Plan Name:HealthPartners Freedom Ultimate (Cost)
Location:Roseau, Minnesota     Click to see other locations
Plan ID:H2462 - 010 - 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 Ultimate (Cost) benefit details
— Medicare Plan Features —
Monthly Premium:$155.60 (see Plan Premium Details below)
Annual Deductible:no drug coverage
Health Plan Type:Cost *
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$3,000
Number of Members enrolled in this plan in Roseau, Minnesota:less than 10 members
Number of Members enrolled in this plan in Minnesota:1,006 members
Number of Members enrolled in this plan in (H2462 - 010):1,193 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
$155.60 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:
  • $3 000 for services you receive from in-network providers.
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
  You pay nothing
** 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
$155.60 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:
  • $3 000 for services you receive from in-network providers.
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
  You pay nothing
Ambulance
You pay nothing
Chiropractic care
Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position):  You pay nothing
Dental services
Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth):  You pay nothing
Preventive dental services:
  • Cleaning (for up to 1 every year):  You pay nothing
  • Dental x-ray(s) (for up to 1 every year):  You pay nothing
  • Oral exam (for up to 1 every year):  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):  10% of the cost
    Diagnostic tests and procedures:  You pay nothing
    Lab services:  You pay nothing
    Outpatient x-rays:  You pay nothing
    Therapeutic radiology services (such as radiation treatment for cancer):  You pay nothing
    Doctor's office visits
    Primary care physician visit:  You pay nothing
    Specialist visit:  You pay nothing
    Durable medical equipment (wheelchairs, oxygen, etc.)
    20% of the cost
    Emergency care
    $50 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:  You pay nothing
    Hearing services
    Exam to diagnose and treat hearing and balance issues:  You pay nothing
    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.
    • $100 copay per stay
    • You pay nothing per day for days 91 and beyond
      • Outpatient group therapy visit:  You pay nothing
      Outpatient individual therapy visit:  You pay nothing
      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:  You pay nothing
      Physical therapy and speech and language therapy visit:  You pay nothing
      Outpatient substance abuse
      Group therapy visit:  You pay nothing
      Individual therapy visit:  You pay nothing
      Outpatient surgery
      Ambulatory surgical center:  $50 copay
      Outpatient hospital:  $0-50 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
      You pay nothing
      Vision services
      Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening):  You pay nothing
      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:
      • 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
      • Colorectal cancer screenings (Colonoscopy Fecal occult blood test Flexible sigmoidoscopy)
      • Depression screening
      • Diabetes screenings
      • 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)
      • Yearly "Wellness" visit
      Any additional preventive services approved by Medicare during the contract year will be covered.
      ** 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.
      • $100 copay per stay
      • You pay nothing per day for days 91 and beyond
        • 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.
        You pay nothing
        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:  You pay nothing
        Hearing services
        Exam to diagnose and treat hearing and balance issues:  You pay nothing
        Routine hearing exam (for up to 1 every year):  You pay nothing
        ** Outpatient Medical Services and Supplies **
        Outpatient substance abuse
        Group therapy visit:  You pay nothing
        Individual therapy visit:  You pay nothing
        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:
          • Comprehensive Dental
          • Preventive Dental
        Additional $39.90 per month. You must keep paying your Medicare Part B premium and your $155.60 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:
          • Comprehensive Dental
          • Preventive Dental
        Additional $39.90 per month. You must keep paying your Medicare Part B premium and your $155.60 monthly plan premium.
        $50 per year.
        Our plan pays up to $1 100 every year.




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