Do more of what you love.

Do more of what you love. HealthPartners Freedom (Cost) 2016 Plan Comparison Guide Join the top-rated plan in Minnesota We're the only plan in the state to receive 5 Stars* from The Centers for Medicare and Medicaid Services. Know you have a trusted partner in HealthPartners Freedom. *Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. H2462_91207_03 Accepted 12/14/2015 MNPlanComp

2 952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156

Table of contents Introducing HealthPartners................................... 4 The Freedom network...................................... 4 Words to know........................................... 5 Your options at a glance....................................6-7 Perks to help you do what you love............................. 8-9 Dental coverage......................................... 10 How to enroll........................................... 11 Your resources.......................................... 12 My notes............................................ 13-15 healthpartnersmedicare.com 3

Enjoy your freedom Retirement is a time to do more of what you love. HealthPartners Freedom gives you the care and coverage you need to start your next adventure. Choose from four medical plan options and pair with Part D prescription drug coverage to get the best value. Our Part D coverage is available with Freedom Vital, Balance and Ultimate; Enhanced Part D coverage is available with Freedom Ultimate. Plus, you can choose optional dental coverage. You have the flexibility to build a plan that s right for you. As your health care needs evolve over time, you can make changes to your medical or Part D plans each year. With Freedom, you re not locked in to a primary care clinic or network. You can use your Original Medicare benefits outside of our network or service area at any time. Call HealthPartners Medicare Sales to learn more. Know your network You can search for doctors, specialists and hospitals 24/7 at healthpartners.com/finddr. Or, if you prefer a printed version of the Freedom directory, you can call our Sales team at the numbers on page 12. Wondering where to get care? The Freedom service area includes all of Minnesota and eight Western Wisconsin counties. We have other clinic systems in our network, but here are the ones you re likely most familiar with: HealthPartners Medical Group Park Nicollet Health Services Fairview Health Services University of Minnesota Physicians North Memorial Health Care HealthEast Care System Essentia (Duluth) St. Luke s (Duluth) CentraCare (St. Cloud) St. Cloud Medical Group Central Minnesota Clinics Stillwater Medical Group YOU HAVE OPTIONS Our network includes HealthPartners Clinics, and we re proud of the care they provide. But you can also get care at hundreds of other network clinics. This brochure talks about Minnesota Freedom plan options. If you re interested in Wisconsin Freedom plan options, please contact us. 4 952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156

Words to know Benefit Period: Begins the day you re admitted as an inpatient in a hospital or skilled nursing facility (SNF) and ends when you haven t received inpatient hospital care (or care in a SNF) for 60 days in a row. Annual election period: When you can join or switch your Medicare plan. Coinsurance: The percentage of the total bill you pay when you use a medical service or drug. Copay or Copayment: What you pay when you use a medical service or drug; usually a flat dollar amount, like $15. Coverage gap ( donut hole ): Begins after you and your drug plan have spent a certain amount for covered drugs. When you reach the coverage gap, you ll receive some coverage for generic drugs and a discount on brand name drugs. Creditable Coverage: Prescription drug coverage that is equal to or better than standard Medicare Part D. Deductible: What you pay for a service item or drug before your insurance kicks in. Drug Tier: A system of copays or coinsurance for the different kinds of prescription drugs. Generally, a drug in a lower tier will cost less than a drug in a higher tier. Formulary: A list of medicines that are covered by your plan. Medicare Cost plan: A type of Medicare plan that lets you use benefits outside the plan s network or service area, and covered services within those benefits are paid for by Original Medicare. The Freedom plan is a Medicare Cost plan. Network: Doctors, hospitals, pharmacies and other health care providers who have contracted with your health plan. Typically, plan members get the lowest cost for services when using network providers. Premium: What you pay each month for your health or prescription drug plan. Preventive care: Tests and screenings that can help you avoid illness or improve your health. This includes blood pressure, diabetes and cancer screenings, some vaccines and more. Provider: Any organization, institution or individual that supplies health care services. Service area: The defined geographic region where a health plan accepts members and where the plan s services are provided. Specialty drugs: High-cost medicines used to treat rare conditions. ARE YOUR MEDS COVERED? Visit healthpartners.com/medicarerx to search the Freedom formulary or give us a call. Save on your prescriptions! Tier 1: Preferred Generic Drugs Tier 2: Generic Drugs Tier 3: Preferred Brand Drugs Tier 4: Non-preferred Brand Drugs Tier 5: Specialty Drugs healthpartnersmedicare.com 5

You have options 2016 PLAN BENEFITS FREEDOM BASIC FREEDOM VITAL WITH RX Monthly premium You must continue to pay your Medicare Part B premium. Doctor office visit (Including real-time audio and video technologies) Remote Access Technology Preventive care Diagnostic tests (X-Rays, Lab Services and Radiology Services) Medical: $37.60; Drug: Not offered Medical: $38.90; Drug: $24.40 Total: $63.30 You pay $15 per visit for primary care You pay 20% of the cost. and $40 per visit for specialty or urgent care. You get unlimited access to: virtuwell Electronic visits (e-visit) Scheduled Telephone Visits 100% coverage. You pay $0 for lab services You pay 20% of the cost for diagnostic procedures and tests X-rays diagnostic radiology services (MRI, CT) therapeutic radiology services (cancer treatment) You pay $0 for lab services diagnostic procedures and tests You pay 10% of the cost for X-rays therapeutic radiology services (cancer treatment) You pay 20% of the cost for diagnostic radiology services (MRI, CT) Inpatient hospital You pay $600 per benefit period. You pay $400 per benefit period. Outpatient hospital You pay 20% of the cost. You pay $0 to $150, depending on the service. Emergency care in U.S. You pay $100 per visit. You pay $75 per visit. Ambulatory surgical centers You pay 20% of the cost. You pay $150 per visit. Durable medical equipment You pay 20% of the cost Travel coverage in U.S. In-network coverage for up to 9 months. Preventive dental care Not covered. Not covered. PRESCRIPTION DRUG (PART D) coverage at in-network pharmacies Deductible Not offered. $195 Initial coverage Not offered. Tier 1: $8; Tier 2: $20; Tier 3: $47; Tier 4: $100; Tier 5: 28% Coverage gap Not offered. You pay 58% for generics and 45% for brand drugs. Catastrophic coverage Not offered. You pay 5% or $2.95 for generics and 5% or $7.40 for all brand drugs, whichever is greater. 6 952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156

FREEDOM BALANCE WITH RX FREEDOM ULTIMATE WITH RX FREEDOM ULTIMATE WITH ENHANCED RX Medical: $93.10; Drug: $41.10 Total: $134.20 Medical: $155.60; Drug: $56.90 Total: $212.50 Medical: $155.60; Drug: $198.50 Total: $354.10 You pay $15 per visit. You pay nothing. You get unlimited access to: virtuwell Electronic visits (e-visit) Scheduled Telephone Visits 100% coverage. You pay $0 for lab services X-rays diagnostic procedures and tests therapeutic radiology services (cancer treatment) You pay 20% of the cost for diagnostic radiology services (MRI, CT) You pay $0 for lab services X-rays diagnostic procedures and tests therapeutic radiology services (cancer treatment) You pay 10% of the cost for diagnostic radiology services (MRI, CT) You pay $200 per benefit period. You pay $100 per benefit period. You pay $0 to $100, depending You pay $0 to $50, depending on the service. on the service. You pay $65 per visit. You pay $50 per visit. You pay $100 per visit. You pay $50 per visit. You pay 20% of the cost In-network coverage for up to 9 months. You pay nothing for 1 cleaning, 1 exam and 1 set of X-rays. $175 $170 $150 Tier 1: $7; Tier 2: $18; Tier 3: $47; Tier 4: $100; Tier 5: 29% Tier 1: $7; Tier 2: $16; Tier 3: $47; Tier 4: $100; Tier 5: 29% You pay 58% for generics and 45% for brand drugs. Tier 1: $7; Tier 2: $15; Tier 3: $40; Tier 4: $85; Tier 5: 29% Tier 1: $7; Tier 2: $15; Tier 3: 50%* and costs are further reduced by 50% You pay 5% or $2.95 for generics and 5% or $7.40 for all brand drugs, whichever is greater. *Retail pharmacies and mail-order pharmacies with preferred cost-sharing. You pay 55% of the costs at mail-order pharmacies with standard cost-sharing and costs are further reduced by 50%. healthpartnersmedicare.com 7

Perks to help you do what you love Your plan gives you more than just health care. You ll also get travel coverage, a large provider network, online tools and more. Don t change doctors Love your doctor? So do we. With more than 45,000 doctors in your network, chances are yours is covered. Plus, no referrals are needed. To search the Freedom network, visit healthpartners.com/finddr. Or, give us a call and we can tell you if your doctor is covered. Get care anywhere From home: virtuwell is convenient online care that treats everyday medical conditions such as colds, coughs, ear pain or flu. All from the comfort of your home. Get 24/7 access to nurse practitioners who will give you personalized care and a treatment plan. And, if needed, a prescription sent right to your pharmacy. You ll get unlimited access at no cost. Visit virtuwell.com to learn more. Across the U.S.: Travel with peace of mind. You have in-network coverage nine months out of the year when you travel in the U.S. Plus, you get worldwide emergency and urgently needed care. To use your Extended Absence Benefit, just let Member Services know before you leave. Sick. Click. Cured. Stay active Join the Silver&Fit Exercise & Healthy Aging Program. You can get a membership at a participating fitness club for just $25 a year. Visit silverandfit.com to find a club. Or, if you prefer to work out at home, choose the Home Fitness Program. Pay $10 a year and get up to two Home Fitness kits. You ll also get: The Silver Slate, a quarterly newsletter. Healthy Aging materials (online or DVD). Silver&Fit Connected! *, to track your exercise at a facility, or through a wearable fitness device or app and earn rewards. (These rewards may change, and the purchase of the device or app is not included.) A toll-free customer service hotline to answer questions about the program. Signing up for the Silver&Fit program is easy. Pay the annual fee directly to the participating fitness facility of your choice. Some exceptions may apply. Visit silverandfit.com or call Silver&Fit customer service at 1-877-427-4788 (TTY/TDD 1-877-710-2746) for more information. To enroll in the Home Fitness program, visit silverandfit.com or call Silver&Fit Customer Service to pay your annual fee. *Your use of Silver&Fit Connected! serves as your consent for American Specialty Health Fitness, Inc. (ASH) Fitness to receive information about your tracked activity and to use that data to process and administer available rewards to you under the program. 8 952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156

Show off your smile Get one dental exam, one set of dental X-rays and one dental cleaning at no additional cost with Freedom Balance and Ultimate. If you want more coverage, you can add the optional comprehensive dental benefit for an additional premium. You ll get two preventive cleanings, and coverage for fillings, oral surgery, crowns, prosthetics and more. Save time with pharmacy tools Get your meds your way with HealthPartners mymailrx. Your prescriptions are delivered right to your door. There s no additional cost and shipping is free. Typically, you can expect to receive your prescription drugs within five to eight business days from the time the mail order pharmacy receives your order. Log on to healthpartners.com/mymailrx to sign up. Or, call 612-623-4002 or 800-591-0011. You can also choose to get your medicines from one of our many in-network pharmacies. To see your options, visit healthpartners.com/partdpharmacy. If you prefer a printed copy of our pharmacy directory, call us at the numbers on page 12. Simplify your life with online tools Log on to your account at healthpartners.com to: Get your plan materials online. To sign up for paperless, visit healthpartners.com/gopaperless. Plus, you can email questions about your benefits, eligibility or claims. Track weight, blood pressure and blood sugar levels. You can also record allergies, immunizations, prescriptions and more by creating your online My Health Diary. Create and print a personal directory of the clinics, hospitals and specialists closest to you. Look for doctors and dentists by name, clinic, specialty, language, parking and wait times. Save money with our medical and drug cost calculators. Don t have a myhealthpartners account? Choose Sign up to get started. Get quick advice from our trusted team Don t spend time searching the Web for answers. Call CareLine SM Service or Nurse Navigator SM Program to talk to a registered nurse. They ll be there when you need them. Need support for mental or chemical health? Call Behavioral Health Navigators to get support from one of our experts. healthpartnersmedicare.com 9

Optional comprehensive dental coverage Enroll when you re first eligible or between October 15 and December 31. FREEDOM VITAL, FREEDOM BALANCE AND FREEDOM BENEFIT CATEGORY ULTIMATE Your Cost Dental Coverage for in-network care Monthly Premium $39.90 Preventive and Diagnostic Care $0 (100% coverage) - Routine examinations, cleanings and X-rays Sealants - Pit and fissure sealants Regular and Restorative Care - Fillings and oral surgery 50% of the cost 50% of the cost - Periodontics and endodontics Special Restorative Care - Restorative crowns and onlays Prosthetics - Bridges 50% of the cost 50% of the cost - Dental Implants (up to $500 per calendar year) - Dentures and partial dentures Annual Deductible - For regular and restorative care, special restorative care and prosthetics Annual Maximum Benefit For out-of-network services in the service area, the maximum benefit is $200 and subject to the $1,100 maximum benefit $50 $0 for preventive and diagnostic services $1,100 Preventive and diagnostic services do not apply to the annual maximum for Balance and Ultimate plans. However, these services do apply for Vital. Not offered for Freedom Basic. 10 952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156

Signing up is easy Step 1: Pick your plan Choose the medical plan option that fits you best. Then decide if you want additional coverage, like prescription drug or dental coverage. Step 2: Enroll in one of the following ways Visit healthpartners.com/medicare and choose Compare & enroll Call us at 952-883-7788 or 877-240-8311 Fill out and send in the paper application using the prepaid envelope in your enrollment kit. Or, you can fax it to us at 952-853-8746. Completed enrollment forms that we receive by the last day of the month are generally effective for the first day of the next calendar month. Call us at the numbers on page 12 to order your enrollment kit. Step 3: Relax After you ve enrolled, a member of our Member Services team will call to confirm your enrollment. They'll also review the Freedom plan rules to make sure you understand your new plan. In addition, you'll receive a packet with your member ID card, Evidence of Coverage, drug formulary and other helpful materials. If you have questions before you receive your packet, just give us a call at the numbers on page 12. Have your info handy When filling out your application, you ll be asked to provide: Your contact information Your plan selection Your Medicare number and Part A and/or B enrollment dates Your payment/billing preference Answers to questions that help determine your eligibility and enrollment status Your signature or the signature of your authorized representative When can I enroll in Freedom? You can enroll in a Cost plan, like HealthPartners Freedom, at any time. However, there may be limitations. Call HealthPartners Sales at the numbers on page 12 or visit medicare.gov for more information. Below are common Medicare enrollment periods. The Initial Enrollment Period (IEP) is the 7-month window beginning three months before and ending three months after your 65th birthday month. The Annual Election Period (AEP) runs from October 15 to December 7. The Special Enrollment Period (SEP) is an enrollment period for special circumstances. Check with HealthPartners or medicare.gov for specific rules. The 5-Star SEP runs from December 8 to November 30. During this time, you can make a one-time switch to one of our 5-Star Freedom Medicare Cost plans. ELIGIBILITY To enroll in a Freedom plan, you must: Have Medicare Part B (or have both Part A and Part B) Live in Minnesota Not have end-stage renal disease (ESRD). Some exceptions apply. Call HealthPartners Medicare Sales for more information. healthpartnersmedicare.com 11

Contact us We re here to support you every step of the way. If you have any questions during your research or enrollment, let us know. Medicare Sales: 952-883-5601 or 800-247-7015 TTY 952-883-6060 or 800-443-0156 From October 1 through February 14, we take calls from 8 a.m. to 8 p.m., seven days a week. You ll speak with a representative. From February 15 to September 30, call us 8 a.m. to 8 p.m. Monday through Friday to speak with a representative. On Saturdays, Sundays and Federal holidays, you can leave a message and we ll get back to you within one business day. Email: medicaresales@healthpartners.com online: healthpartners.com/medicare Other helpful Medicare resources: Medicare medicare.gov 800-MEDICARE 24 hours a day, seven days a week Social Security Administration ssa.gov/pgm/medicare.htm 800-772-1213 7 a.m. to 7 p.m. Monday through Friday Senior LinkAge Line mnaging.org/advisor/sll 800-333-2433 8 a.m. to 4:30 p.m. Monday through Friday Come to an informational meeting: Call or visit healthpartners.com/meetings to find a meeting near you. Stop by and see us: HealthPartners Medicare Sales 8170 33rd Ave S Bloomington, MN 55425 12 952-883-5601 or 800-247-7015; TTY 952-883-6060 or 800-443-0156

Questions to ask when you re shopping Can I keep my doctor? Do I need referrals to see specialists? Are my medicines covered? Am I covered if I travel? What options do I have if I need to change my level of coverage in the future? Notes healthpartnersmedicare.com 13

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HealthPartners is a Cost plan with a Medicare contract. Enrollment in HealthPartners depends on contract renewal. If you attend a community meeting, a sales person will be present with information and applications. For accommodations of persons with special needs at sales meetings, call HealthPartners Medicare Sales at the numbers on page 12. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary. The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). All programs and services are not available in all areas. Silver&Fit, Silver&Fit Connected!, the Silver&Fit logo, and The Silver Slate are federally registered trademarks of ASH and used with permission herein. 8170 33 rd Ave S Bloomington MN, 55425 8501 (12/15) 2015 HealthPartners