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Prescription drug coverage (Part D)

What is Part D?

If you’re eligible for Medicare, you can sign up for prescription drug coverage – Part D

You may choose to include this optional coverage as part of your Freedom plan, or enroll in a stand-alone Part D prescription drug plan with a different company. Look below for more information about which plans include optional prescription drug coverage.

Watch a video on the four stages of Part D

Below is a chart that shows Freedom plan options with Part D for Minnesota residents.

  Freedom Vital with Rx (Cost) Freedom Active with RX (Cost) Freedom Balance with Rx (Cost) Freedom Ultimate with Rx(Cost) Freedom Ultimate with Enhanced Rx (Cost)
Monthly Premium (Medical + Rx = Total) $38.90 + $31.50
Total: $70.40
$69.90 + $41.30
Total: $111.20
$89.90 + $51.00
Total: $140.90
$160.20 + $70.80
Total: $231.00
$160.20 + $203.70
Total: $363.90
Deductible Tiers 1-5: $195 Tiers 1-5: $180 Tiers 1-5: $175 Tiers 1-5: $170 Tiers 1-5: $150
Initial Coverage (until costs reach $3,700) Tier 1: $6;
Tier 2: $20;
Tier 3: $47;
Tier 4: $100;
Tier 5: 28%
Tier 1: $6
Tier 2: $19
Tier 3: $47
Tier 4: $100
Tier 5: 29%
Tier 1: $6;
Tier 2: $19;
Tier 3: $47;
Tier 4: $100;
Tier 5: 29%
Tier 1: $7;
Tier 2: $16;
Tier 3: $47;
Tier 4: $100;
Tier 5: 29%
Tier 1: $7;
Tier 2: $15;
Tier 3: $40;
Tier 4: $85;
Tier 5: 29%
Coverage Gap (after you and the plan pay $3,700) You pay 51% for generics and 40% for brand drugs You pay 51% for generics and 40% for brand drugs You pay 51% for generics and 40% for brand drugs You pay 51% for generics and 40% for brand drugs Tier 1: $7;
Tier 2: $15;
Tier 3: 50%* and costs are further reduced by 50%
Catastrophic Coverage (after your payments alone reach $4,950) You pay 5% or $3.30 for generics and 5% or $8.25 for all brand drugs, whichever is greater You pay 5% or $3.30 for generics and 5% or $8.25 for all brand drugs, whichever is greater You pay 5% or $3.30 for generics and 5% or $8.25 for all brand drugs, whichever is greater You pay 5% or $3.30 for generics and 5% or $8.25 for all brand drugs, whichever is greater You pay 5% or $3.30 for generics and 5% or $8.25 for all brand drugs, whichever is greater

Tier label

Tier 1 – Preferred Generic Drugs
Tier 2 – Generic Drugs
Tier 3 – Preferred Brand Drugs
Tier 4 – Non-preferred Brand Drugs
Tier 5 – Specialty Drugs

*At retail and mail order pharmacies with preferred cost sharing. You pay 55% of the costs at mail order pharmacies with standard cost sharing.

Below is a chart that shows the Wisconsin Freedom plan option with Part D.

  Wisconsin Freedom Balance with Rx (Cost)
Monthly Premium (Medical + Rx = Total)

$99.00 + $55.10
Total: $154.10

Deductible $400 annual deductible
Initial Coverage (until costs reach $3,700) After you pay for yearly deductible, you pay 25% until total yearly drug costs reach $3,700
Coverage Gap (after you and the plan pay $3,700) You pay 51% for generics and 40% for brand drugs
Catastrophic Coverage (after your costs alone reach $4,950) You pay 5% or $3.30 for generics and 5% or $8.25 for all brand drugs, whichever is greater

MSHO, for people who are on Medical Assistance or Medicare Parts A and B

Part D Your copay, depending on your income level and institutional status
Generic Drugs or Brands treated as Generics $0/$1.20/$3.30
Brand Name Drugs $0/$3.70/$8.25
Disclaimer:

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary.

HealthPartners MSHO is a health plan that contracts with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. HealthPartners Freedom is a Cost plan with a Medicare contract. Enrollment in HealthPartners depends on contract renewal.

Last updated October 2016
H2422_97688 Approved
H2462_97688 Approved

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