A balanced plan with affordable premium. You pay $15 copays for most services.
Prescription drug (Part D) coverage is available with Freedom Balance (Cost), as well as dental coverage.
- View the Plan Options brochure
- View the Medical Summary of Benefits or Medical with Rx Summary of Benefits
- View the Evidence of Coverage
Optional prescription drug coverage
- You have a deductible of $125
- You pay $10 for generics, $45 for preferred brand, $95 for non-preferred brand and 33 percent for specialty drugs
Optional dental coverage
- In addition to what is covered under your medical plan, you get two additional preventive cleanings/exams per year
- You pay 50 percent coverage for fillings, oral surgery, crowns, dentures and other services
Other features of this plan include:
- Three free visits to virtuwell
- The Silver&Fit® fitness program
- Access to Healthly Discounts*
- Extended Absence Benefit (travel coverage)
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premiums and/or copayments may change on January 1, 2013. You must continue to pay your Medicare Part B premium.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call:
- 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048, 24 hours a day/7 days a week.
- The Social Security Office at 800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 800-325-0778.
- Or your Medicaid Office.
*The products and services described under Healthy Discounts are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the HealthPartners grievance process.