HealthPartners Freedom Plains (Cost) is a Medicare Advantage (Part C) Plan by HealthPartners.
This page features plan details for 2024 HealthPartners Freedom Plains (Cost) H2462 – 023 – 0 available in Select Counties in ND and SD.
IMPORTANT: This page has been updated with plan and premium data for 2024.
HealthPartners Freedom Plains (Cost) is offered in the following locations.
HealthPartners Freedom Plains (Cost) offers the following coverage and cost-sharing.
Insurer: | HealthPartners |
Health Plan Deductible: | $0.00 |
MOOP: | $3,400 In-network |
Drugs Covered: | No |
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Part B | Part C | Part B Give Back | Total |
---|---|---|---|
$174.70 | $39.70 | $0.00 | $214.40 |
HealthPartners Freedom Plains (Cost) also provides the following benefits.
$0 |
In-network | No |
$3,400 In-network |
No |
In-network | No |
$150 copay per visit (Authorization is required.) (Referral is not required.) |
Primary | $0 copay (Not applicable.) (Not applicable.) |
Specialist | $40 copay per visit (Authorization is not required.) (Referral is not required.) |
$0 copay (Authorization is not required.) (Referral is not required.) |
Emergency | $135 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Urgent care | $40 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Diagnostic tests and procedures | $40 copay (Authorization is not required.) (Referral is not required.) |
Lab services | $0 copay (Authorization is not required.) (Referral is not required.) |
Diagnostic radiology services (e.g., MRI) | $150 copay (Authorization is required.) (Referral is not required.) |
Outpatient x-rays | $10 copay (Authorization is required.) (Referral is not required.) |
Hearing exam | $40 copay (Authorization is not required.) (Referral is not required.) |
Fitting/evaluation | $0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
Hearing aids | $499-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Oral exam | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Cleaning | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Dental x-ray(s) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Periodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Upgrades | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Occupational therapy visit | $40 copay (Authorization is not required.) (Referral is not required.) |
Physical therapy and speech and language therapy visit | $40 copay (Authorization is not required.) (Referral is not required.) |
$200 copay (Not applicable.) (Not applicable.) |
Not covered (Not applicable.) (Not applicable.) |
Foot exams and treatment | $40 copay (Authorization is not required.) (Referral is not required.) |
Routine foot care | Not covered (Not applicable.) (Not applicable.) |
Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
Diabetes supplies | $0 copay (Authorization is required.) (Not applicable.) |
Covered (Authorization is not required.) (Referral is not required.) |
Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Part B Insulin drugs | 0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.) |
$400 per stay (Authorization is required.) (Referral is not required.) |
Inpatient hospital – psychiatric | $400 per stay (Authorization is not required.) (Referral is not required.) |
Outpatient group therapy visit with a psychiatrist | $20 copay (Authorization is not required.) (Referral is not required.) |
Outpatient individual therapy visit with a psychiatrist | $40 copay (Authorization is not required.) (Referral is not required.) |
Outpatient group therapy visit | $20 copay (Authorization is not required.) (Referral is not required.) |
Outpatient individual therapy visit | $40 copay (Authorization is not required.) (Referral is not required.) |
$0 per day for days 1 through 20 $203 per day for days 21 through 100 (Authorization is not required.) (Referral is not required.) |
Ready to sign up for HealthPartners Freedom Plains (Cost) ?
SMID: MULTIPLAN_HCIHNDOGMED01_M
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