Medicare resources and forms

HealthPartners has expansive networks of doctors, clinics and pharmacies where you live, so you can get quality care at a lower cost.

If you’re already a member, it’s easiest to sign in to search your provider or pharmacy network.

If you’re not already a member, you can use our network search tools to see if your doctors, clinics and pharmacies are covered.

If you have a Medicare Advantage plan through HealthPartners, it may include Medicare Part D prescription drug coverage. Plans with Part D have a formulary, which is a list of covered drugs.

Our individual Medicare Advantage plans use our Formulary I drug list.

Looking for something else? On our formulary resources page, you can find:

You can also sign up for the Medicare Prescription Payment Program or, if you qualify, the Medicare Extra Help/LIS program.

Most HealthPartners Medicare plans include in-network coverage for up to nine consecutive months of the year when you travel inside the U.S. but outside your plan’s service area, so your benefits travel right alongside you.

Let us know when you plan to travel. Just call the number on the back of your insurance card or sign in to your account to activate your travel benefits.

Most plans also offer access to pre-travel consultations and worldwide emergency and urgent care coverage, with additional assistance available through Assist America ^®.*

• Call 800-872-1414 inside the U.S. or +1-609-986-1234 outside the U.S. to talk to experienced clinicians 24/7 who can help assess your need for medical care.
• If appropriate medical care isn’t available locally, Assist America will coordinate your transportation to the nearest facility or to your home.

With MTM, you can receive one-on-one help from a pharmacist to be sure you’re getting the most out of your medicines. It’s available at no extra cost with any HealthPartners Medicare plan that includes prescription drug coverage, like most of our Medicare Advantage plans.

• Diabetic supply list (PDF)
• Prior authorization list and Part B step therapy list (PDF) – This list contains prior authorization (PA) and step therapy requirements for network providers regarding certain services and Part B drugs.

Your EOC and ANOC are legal documents that provide complete information about how your Medicare plan works:

• Your EOC explains what your plan covers, how much you pay and more.
• Your ANOC describes changes to your plan's coverage, costs or administration for the upcoming year. ANOCs are issued in October, and the changes they describe take effect the following January.

Your Summary of Benefits outlines what your plan covers and what you’ll pay for those services. It doesn’t list everything covered by your plan, or every limitation or exclusion. For a full list of covered services, see your Evidence of Coverage.

• HealthPartners^® Journey (PPO) Metro-Central – Summary of Benefits (PDF)
• HealthPartners^® Journey (PPO) Greater MN – Summary of Benefits (PDF)
• HealthPartners^® Minnesota Senior Health Options (HMO SNP) – Summary of Benefits (PDF)

• HealthPartners^® Freedom WI (Cost) – Summary of Benefits (PDF)
• HealthPartners^® Robin (PPO) – Summary of Benefits (PDF)

• HealthPartners^® Freedom (Cost) – Summary of Benefits (PDF)

If you have concerns about the care you received, you can find information on filing an appeal or grievance or requesting a coverage decision.

You can also learn about appointing a representative (PDF) and completing the form (PDF) . In addition, you can take a look at the Medicare complaint form and see information from the Medicare Ombudsman Center .

• HealthPartners Journey Medicare Advantage star ratings (PDF) in Minnesota
• HealthPartners Robin Medicare Advantage star ratings (PDF) in Wisconsin
• HealthPartners Cost star ratings (PDF) in Wisconsin, North Dakota and South Dakota
• HealthPartners MSHO (HMO SNP) star ratings (PDF) in Minnesota

The Centers for Medicare & Medicaid Services (CMS) may release National Coverage Determinations (NCDs) throughout the year. NCDs inform Medicare beneficiaries of new services or therapies that are covered (or changed) under Original Medicare.

If a new NCD impacts services covered by your HealthPartners Medicare plan or MSHO plan, we post it here. Previous NCDs include:

• September 2024 – Preexposure Prophylaxis (PrEP) Using Antiretroviral Therapy to Prevent Human Immunodeficiency Virus (HIV) Infection (PDF)
• March 2024 – Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndromes (MDS) (PDF)
• October 2023 – PTA of the Carotid Artery Concurrent with Stenting (PDF)
• October 2023 – Beta Amyloid PET in Dementia and Neurodegenerative Disease (PDF)
• May 2023 – Seat Elevation Systems as an Accessory to Power Wheelchairs (PDF)
• September 2022 – Cochlear Implantation (PDF)
  
• July 2022 – Decision to Amend NCD 240.2 Home Use of Oxygen (PDF)
• April 2022 – Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease (PDF)
• February 2022 – Screening for Lung Cancer with Low Dose Computed Tomography (LDCT)
• October 2021 – Transvenous (Catheter) Pulmonary Embolectomy (PDF)
• September 2021 – Home Use of Oxygen and Oxygen Equipment (PDF)
• January 2021 – Screening for Colorectal Cancer – Blood-Based Biomarker Tests (PDF)
• January 2021 – Transcatheter Mitral Valve Repair (TMVR) (PDF)
• December 2020 – Artificial Hearts and related devices, including Ventricular Assist Devices for Bridge-to-Transplant and Destination Therapy (PDF)
• January 2020 – Next Generation Sequencing for Medicare Beneficiaries with Advanced Cancer (PDF)
• January 2020 – Acupuncture for Chronic Low Back Pain (PDF)

It might also be helpful to visit the CMS Medicare Coverage Database .

Use these Medicare resources to find more information about:

• SilverSneakers
• Getting care during a disaster (PDF)
• Nondiscrimination notice and language assistance (PDF)
• Multilanguage insert (PDF)