HealthPartners Freedom 2015 Plan Comparison Guide · Save on your prescriptions! 952-883-5601 or...

H2462_82441 Accepted 9/14/2014 MNPlanComp

HEALTHPARTNERS® FREEDOM 2015 PLAN COMPARISON GUIDE

2 952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156

HEALTHPARTNERS® FREEDOM PLAN

3 healthpartners.com/medicare

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

4 952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156


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!

http://www.medicare.gov

mailto:[email protected]

http://www.healthpartners.com/medicare


GETTING STARTED

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



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.




Emergency care (in U.S.)

You pay $100 per visit.

You pay $75 per visit. You pay $65 per visit. You pay $50 per visit.

Travel coverage

Coverage for up to 9 months within U.S.

Prescription drug (Part D) coverage**

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: $12; Tier 3: $40; Tier 4:

$65; Tier 5: 33%

Coverage gap Not offered. 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%

Catastrophic coverage

Not offered. 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%.

QUICK REFERENCE: 2015 FREEDOM PLAN COMPARISON

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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.

Sick. Click. Cured. Freedom members get

unlimited visits!

*Rewards subject to change; purchase of device or app is not included

New for 2015! Unlimited Electronic visits (E-visit) and Scheduled Telephone Visits.

To learn more, call HealthPartners Medicare Sales at the numbers on page 28.

Not all doctors and clinics are set up to do these visits. Check with your provider for the availability of this option.

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!

• 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.

• Healthy Aging materials (online or DVD)

• 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.

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.

http://silverandfit.com

http://www.silverandfit.com


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 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.

• 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

*Other pharmacies are available in our network.

http://www.healthpartners.com/myMailRx

http://www.healthpartners.com/pharmacy

http://www.healthpartners.com/discounts


952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156 8

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:

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)

CentraCare (St. Cloud)

St. Cloud Medical Group

Other providers are available in our network.

Freedom Service Area

Includes all of Minnesota and eight Western Wisconsin counties.

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.

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.

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. V

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GETTING STARTED

9healthpartners.com/medicare

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:

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

• Answers to questions that help determine your eligibility and enrollment status

• Your signature or the signature of your authorized representative

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!

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.



MEDICARE OVERVIEW 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.

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.

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.

10 952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156

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.

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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.



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


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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.

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.

MonthlyPremium* Freedom Basic Freedom Vital

Medical Plan Only $47 $54

Rx (Part D) Not offered $10

Enhanced Rx (Part D) Not offered Not offered

Medical andRx Combined

Not offered $64

Out-of-pocketMaximum

Not offered $3,000

PLAN DETAILS



$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.


Your Cost Your Cost

$0 (100% coverage) $0 (100% coverage)

You pay $0 for:

- Additional smoking cessation

- Nursing hotline

You pay an annual $25 or $10 fee for Silver&Fit®

You pay $0 for:


- Nursing hotline


You pay $0 for:

- 1 preventive exam

- 1 cleaning

- 1 set of X-rays

Comprehensive dental coverage is available.See pages 26-27.

You pay $0 for:

- 1 preventive exam

- 1 cleaning

- 1 set of X-rays

Comprehensive dental coverage is available.See pages 26-27.

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.



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.


952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156

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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:

- Nursing hotline

You pay $0 for:


- Nursing hotline


Preventive Dental Care Not covered Not covered, but you can select optional preventive and comprehensive dental coverage. See pages 26-27.

Travel Benefit

Out of State Within the U.S. (Extended Absence Benefit)





Out of the U.S. Not covered. Worldwide coverage for urgent or emergency care. You pay 20% of the cost.

Benefit Category

Freedom Basic Freedom Vital

* In-network providers

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.

BenefitCategory


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:

- Nursing hotline

You pay $0 for:


- Nursing hotline


Preventive Dental Care Not covered Not covered, but you can select optional preventive and comprehensive dental coverage.See pages 26-27.

Travel Benefit

Out of State Withinthe U.S. (Extended Absence Benefit)





Out of the U.S. Not covered. Worldwide coverage for urgent or emergencycare. You pay 20% of the cost.

PLAN DETAILS

healthpartners.com/medicare

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Your Cost Your Cost


You pay $0 for:


- Nursing hotline


You pay $0 for:


- Nursing hotline


You pay $0 for:

- 1 preventive exam

- 1 cleaning

- 1 set of X-rays

Comprehensive dental coverage is available. See pages 26-27.

You pay $0 for:

- 1 preventive exam

- 1 cleaning

- 1 set of X-rays

Comprehensive dental coverage is available. See pages 26-27.





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.


Your Cost Your Cost

$15 copay $0 copay

$15 copay

20% of the cost outside the U.S.

$0 copay


You get unlimited access to and pay $0 for:

- virtuwell®

- Electronic visits (E-visit)

- Scheduled Telephone Visits


- virtuwell®



$0 copay for

- lab services

- X-rays

- diagnostic procedures and tests

- therapeutic radiology services (cancer treatment)

20% of the cost for diagnostic radiology services (MRI, CT)

$0 copay for

- lab services

- X-rays




$15 copay/individual therapy visit

$7.50 copay/group therapy visit

$0 copay

$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


952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156

Your Cost Your Cost

Office Visit/Outpatient Services*

Primary Care Doctor/ Specialist/Convenience Care

20% of the cost $15 primary copay

$40 specialist copay

Urgent Care 20% of the cost

Not covered outside the U.S.

$40 copay


Web/Phone Based Technologies


- virtuwell®




- virtuwell®



Diagnostic Tests, X-Rays, Lab Services and Radiology Services

$0 copay for lab services

20% of the cost for


- X-rays

- diagnostic radiology services (MRI, CT)




10% of the cost for

- X-rays



Outpatient Mental Health

20% of the cost for individual or group therapy visits.


$20 copay/group 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**


Cardiac and Pulmonary Rehabilitation Services


Benefit Category


* In-network providers ** Occupational and physical therapy, speech and language pathology

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BenefitCategory


Your Cost Your Cost

Office Visit/Outpatient Services*

Primary Care Doctor/Specialist/ConvenienceCare

20% of the cost $15 primary copay

$40 specialist copay

Urgent Care 20% of the cost

Not covered outside the U.S.

$40 copay


Web/Phone BasedTechnologies


- virtuwell®




- virtuwell®



Diagnostic Tests,X-Rays, Lab Services and Radiology Services


20% of the cost for


- X-rays

- diagnostic radiology services (MRI, CT)




10% of the cost for

- X-rays



OutpatientMental Health

20% of the cost for individual or group therapy visits.


$20 copay/group therapy visit

Outpatient Substance Abuse


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**


Cardiac and Pulmonary Rehabilitation Services


PLAN DETAILS


Freedom Balance

Your Cost

Freedom Ultimate

Your Cost

$15 copay $0 copay

$15 copay


$0 copay



- virtuwell®




- virtuwell®



$0 copay for

- lab services

- X-rays




$0 copay for

- lab services

- X-rays





$7.50 copay/group therapy visit

$0 copay

$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

17


Your Cost Your Cost

$200 copay for each benefit period

$0 copay for additional non-Medicare-covered hospital days

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





$0 copay

Plan covers up to 100 days each benefit period

$0 copay



952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156

Your Cost Your Cost

Hospital, Inpatient*

Inpatient Hospital Care

(Includes Mental Health, Substance Abuse and Rehabilitation Services)


Plan covers 90 days each benefit period

You get up to 190 days in a psychiatric hospital in a lifetime

Plan covers 60 lifetime reserve days

$0 copay per lifetime reserve stay





Skilled Nursing Facility (SNF)**

(In a Medicare-certified skilled nursing facility)

Days 1-20 $0 copay per day






Benefit Category


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**Medically necessary intermittent skilled nursing care, home health aide services, rehabilitation services

BenefitCategory


Your Cost Your Cost

Hospital, Inpatient*

Inpatient HospitalCare

(Includes Mental Health,Substance Abuse andRehabilitation Services)


Plan covers 90 days each benefit period

You get up to 190 days in a psychiatric hospital in a lifetime

Plan covers 60 lifetime reserve days

$0 copay per lifetime reserve stay





Skilled Nursing Facility (SNF)**

(In a Medicare-certified skilled nursing facility)







PLAN DETAILS


Freedom Balance

Your Cost

Freedom Ultimate

Your Cost









$0 copay


$0 copay


19

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.


Your Cost Your Cost

$100 copay $50 copay

$0 copay $0 copay

20% of the cost 20% of the cost


$0 copay $0 copay


$0 copay

$0 copay for education services

$0 copay


$0 copay $0 copay


952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156

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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


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


Other Services*

Home Health Care** $0 copay $0 copay

Benefit Category



** Medically necessary intermittent skilled nursing care, home health aide services, rehabilitation services

BenefitCategory


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


Prosthetic Devices 20% of the cost 20% of the cost

DiabetesSelf-MonitoringTraining, NutritionTherapy

$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


Other Services*

Home Health Care** $0 copay $0 copay

PLAN DETAILS


21


Your Cost Your Cost

$100 copay $50 copay

$0 copay $0 copay



$0 copay $0 copay


$0 copay


$0 copay


$0 copay $0 copay


Your Cost Your Cost


$65 copay in U.S.


$50 copay in U.S.


$0 copay

$0 to $15 copay for annual glaucoma screening

$0 copay

$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%-20% of the cost

$0 copay for Part B injections in a physician’s office

0%-20% of the cost



952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156

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Your Cost Your Cost

Emergency Services*

Ambulance Services 20% of the cost 20% of the cost

Emergency Room Visit**

$100 copay in U.S.

Not covered outside the U.S. except under limited circumstances. Contact the plan for more details.

$75 copay in U.S.


Hearing/Vision Services*

Annual Routine Check Not covered

0% to 20% of the cost for annual glaucoma screening

$0 copay


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


Drugs Covered Under Medicare Part B*

20% of the cost 0%-20% of the cost


Benefit Category



** If you are admitted to the hospital within 24-hours for the same condition, you pay $0 for the emergency room visit.

BenefitCategory


Your Cost Your Cost

Emergency Services*

Ambulance Services 20% of the cost 20% of the cost

Emergency Room Visit**

$100 copay in U.S.

Not covered outside the U.S. except under limited circumstances. Contact the plan for more details.

$75 copay in U.S.


Hearing/Vision Services*

Annual Routine Check Not covered

0% to 20% of the cost for annual glaucoma screening

$0 copay


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


Drugs Covered Under Medicare Part B*

20% of the cost 0%-20% of the cost


PLAN DETAILS


23


Your Cost Your Cost


$65 copay in U.S.


$50 copay in U.S.


$0 copay


$0 copay

$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%-20% of the cost


0%-20% of the cost


Freedom Ultimate with Rx Freedom Ultimate with Enhanced Rx

Your Cost Your Cost

$151 + $39.70

Total: $190.70

$151 + $196.10

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.


*** 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%.


OPTIONAL PRESCRIPTION DRUG COVERAGE

Your Your Cost Your Cost Cost

Prescription Drug Coverage Under Medicare Part D*

Monthly Premium **

(Medical + Rx = Total)

Not offered $54 + $10

Total: $64

$94 + $24.80

Total: $118.80

Deductible Not offered Tiers 1-4: $175; Tier 5: none Tiers 1-4: $125; Tier 5: none

Initial Coverage

(until you and the plan pay $2,960)

Not offered Tier 1: $5; Tier 2: $20; Tier 3: $45; Tier 4: $95; Tier 5: 33%


Coverage Gap

(after you and the plan pay $2,960)

Not offered You pay 65% for generics and 45% for brand drugs.

You pay 65% for generics and 45% for brand drugs.

Catastrophic Coverage

(after only you pay $4,700)

Not offered You pay 5% or $2.65 for generics and 5% or $6.60 for all brand drugs, whichever is greater.


Benefit Category

Freedom Basic Freedom Vital with Rx Freedom Balance

with Rx

* 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.

24

Save on your prescriptions!

952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156

$ Preferred Generic Drugs

$$ Non-preferred Generic Drugs

$$$ Preferred Brand Drugs

$$$$ Non-preferred Brand Drugs

$$$$$ Specialty Drugs

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.

Benefit Category

FreedomBasic Freedom Vital with Rx Freedom Balance

with RxYour Cost Your Cost Your Cost

Prescription Drug Coverage Under Medicare Part D*

Monthly Premium **

(Medical + Rx = Total)

Not offered $54 + $10

Total: $64

$94 + $24.80

Total: $118.80

Deductible Not offered Tiers 1-4: $175; Tier 5: none Tiers 1-4: $125; Tier 5: none

Initial Coverage

(until you and the plan pay $2,960)

Not offered Tier 1: $5; Tier 2: $20; Tier 3: $45; Tier 4: $95; Tier 5: 33%


Coverage Gap

(after you and the plan pay $2,960)

Not offered You pay 65% for generics and 45% for brand drugs.

You pay 65% for generics and 45% for brand drugs.

Catastrophic Coverage

(after only you pay $4,700)

Not offered You pay 5% or $2.65 for generics and 5% or $6.60 for all brand drugs, whichever is greater.


* 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.

OPTIONAL PRESCRIPTION DRUG COVERAGE

PLAN DETAILS


Freedom Ultimate with Rx Freedom Ultimate with Enhanced Rx

Your Cost Your Cost

$151 + $39.70

Total: $190.70

$151 + $196.10

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%



*** 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.

25

http://www.healthpartners.com/medicarerx


Your Cost Your Cost

$39.90 $39.90






$50

$0 for preventive and diagnostic services

$50


$1,100**

Preventive and diagnostic services do not apply to the annual maximum.

$1,100**



952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156

OPTIONAL DENTAL COVERAGE Enroll when you’re first eligible or between October 15 and December 31.

Your Cost Your Cost

Dental Coverage *

Monthly Premium Not offered $39.90

Preventive and Diagnostic Care

- Routine examinations, cleanings and X-rays

Not offered $0 (100% coverage)

Sealants

- Pit and fissure sealants

Not offered 50% of the cost

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

Not offered $50


Annual Maximum Benefit Not offered $1,100**

Preventive and diagnostic services do apply to the annual maximum.

Benefit Category Freedom Basic Freedom Vital

*In-network **For out-of-network services in the service area, the maximum benefit is $200 and subject to the $1,100 maximum benefit

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Benefit CategoryFreedom Basic Freedom Vital

Your Cost Your Cost

Dental Coverage *

Monthly Premium Not offered $39.90

Preventive and Diagnostic Care

- Routine examinations, cleaningsand X-rays

Not offered $0 (100% coverage)

Sealants

- 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

Not offered $50


Annual Maximum Benefit Not offered $1,100**

Preventive and diagnostic services do apply to the annual maximum.

PLAN DETAILS


Freedom Balance

Your Cost

Freedom Ultimate

Your Cost

$39.90 $39.90






$50


$50


$1,100**


$1,100**


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Other helpful resources for Medicare decision-making:

MEDICARE

medicare.gov

800-MEDICARE

24 hours a day, seven days a week

SOCIAL SECURITY ADMINISTRATION

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

800-333-2433

8 a.m. to 4:30 p.m. Monday through Friday

CONTACT US At any time during your research and enrollment process, knowledgeable HealthPartners representatives are standing by to help answer your questions.

CALL MEDICARE SALES:

952-883-5601 or 800-247-7015

TTY 952-883-6060 or 800-443-0156

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.

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:

[email protected]

GO ONLINE:


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!

952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156 28

mailto:[email protected]



http://www.ssa.gov/pgm/medicare.htm

http://www.mnaging.org/advisor/SLL

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?

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8170 33rd Ave S Bloomington MN, 55425

3549 (8/14) ©2014 HealthPartners

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.

HealthPartners Freedom 2015 Plan Comparison Guide · Save on your prescriptions! 952-883-5601 or...

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