Plan ID: H2462-027

What You Need to Know:

  • HealthPartners Freedom Vital WI (Cost) is a Medicare Advantage Health Maintenance Organization Cost * plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $40, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is no drug coverage.
  • The plan includes an out-of-pocket maximum of $3,400 per year (in-network).
  • HealthPartners Freedom Vital WI (Cost) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is no drug coverage.
  • This plan's Part D Initial Coverage Limit is .

$40

Monthly Premium

Medicare Plan Features
Monthly Premium: $39.70
Part C Premium: NULL
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$39.70 NULL NULL NULL NULL NULL NULL
Gap Coverage: NULL
Benchmark: NULL
Type of Medicare Health: NULL
Health Plan Type: Cost *
Similar Plan: H2462-028
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: NULL
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $3,400
Annual Deductible: no drug coverage
Annual Initial Coverage Limit ICL: NULL
Number of Members enrolled in this plan in St. Croix, Wisconsin: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
309 members 4.5 out of 5 Stars. Insufficient data to rate this plan. 5 out of 5 Stars.
Plan Offers Mail Order: NULL
Plan Health Benefits
Total # of Formulary Drugs: NULL
Number of Members Enrolled in this Plan in St. Croix, Wisconsin: 640 members
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
NULL NULL NULL NULL
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
NULL NULL NULL NULL NULL NULL NULL
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
NULL NULL NULL NULL NULL NULL NULL NULL NULL NULL

Other Medicare Advantage Plans in St. Croix, Wisconsin

Plan Name Type Premium MOOP Rx Deduct. Rating
Medica Prime Solution Thrift (Cost) (2023)Cost *$6,700$-
5
Medica Prime Solution Focus (Cost) (2023)Cost *$4,000$-
5
HumanaChoice R5361-002 (Regional PPO) (2023)Regional PPO$6,700$420
5
Medica Prime Solution Total (Cost) (2023)Cost *$3,000$-
5
HealthPartners Freedom Basic WI (Cost) (2023)Cost *$-$-
Insufficient data to rate this plan.
HealthPartners Freedom Balance WI (Cost) (2023)Cost *$3,400$-
Insufficient data to rate this plan.
HumanaChoice H5216-063 (PPO) (2023)Local PPO$3,200$250
4
HumanaChoice H5216-167 (PPO) (2023)Local PPO$4,500$350
4
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
HumanaChoice R5361-001 (Regional PPO) (2023)Regional PPO *$6,700$-
5
Secure Saver (MSA) (2023)MSA *$-$-
4
NetworkPrime (MSA) (2023)MSA *$-$-
4
Medicare Advantage Plans by HealthPartners
HealthPartners Freedom Basic WI (Cost) (2023)Cost *$-$-
Insufficient data to rate this plan.
HealthPartners Freedom Balance WI (Cost) (2023)Cost *$3,400$-
Insufficient data to rate this plan.

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