Choose from two medical plan options: Wisconsin Freedom Basic (Cost) or Wisconsin Freedom Ultimate (Cost). Prescription drug coverage is available with Wisconsin Freedom Ultimate. There are no dental coverage options offered with either plan.
|
|
Freedom Wisconsin Basic |
Freedom Wisconsin Ultimate |
|---|---|---|
Monthly premium |
$62 | $236 |
Monthly premium with Rx |
Rx not offered | $258.50 |
Routine physical exams and preventive care |
$0 copay (100% covered) | |
Primary care doctor or specialist |
20% of the cost | $0 copay |
virtuwell®24/7 online clinic |
First three virtuwell visits are free! After that, member pays no more than $40 per visit. What is virtuwell? |
|
Hospital |
$300 out-of-pocket limit every benefit period | $0 copay |
Durable medical equipment |
20% of the cost | $0 copay |
Emergency room |
$100 copay in the U.S. | $0 copay in the U.S. |
Coverage outside the service area |
Coverage for up to 9 months within the U.S. Just call Member Services to activate! More about the Extended Absence Benefit. |
|
Coverage outside the U.S. |
No coverage | You pay 20% of the cost for urgently needed and emergency care worldwide. |
Hearing services |
Annual routine check not covered. 20% of the cost for diagnostic exams. Hearing aid discounts of up to 30 percent. | $0 copay for annual routine check. $0 copay for diagnostic exams. Hearing aid discounts of up to 30 percent. |
Vision services |
$0 copay for annual glaucoma screening. 0% to 20% of the cost for diagnostic exams. $0 copay for one pair of eyeglasses or contact lenses after cataract surgery. | $0 copay for annual routine check. $0 copay for diagnostic exams. $0 copay for one pair of eyeglasses or contacts after cataract surgery. |
Dental |
Not offered | |
Fitness |
You have access to Healthy Discounts at more than 40 local and national retailers | |
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premiums and/or copayments may change on January 1, 2013.
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.