Medicare Plan Lookup Official CMS data · Contract Year 2027
CMS 2027 data

2027 Medicare plan code

H2462-028

Medicare Plan

HealthPartners Freedom Balance WI (Cost) · HealthPartners · 1876 Cost · Select Counties in Western WI

Full CMS plan ID: H2462-028-000

H2462-028-000 is the full CMS identifier for the H2462-028 Medicare plan. Common searches include H2462 028 and H2462028.

2027

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2027 plan record

HealthPartners Freedom Balance WI (Cost)

H2462-028-000 Select Counties in Western WI 1876 Cost

At-a-glance

Quick view

01

In-network

Inpatient hospital

Per admission $400 per stay
Out-of-network

Not separately reported

Point of service

Not separately reported

02

Emergency transport

Ambulance

Ground · in-network$100 copay
Air · in-network$100 copay
03

Emergency services

Emergency room

$140 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$4,000
Combined in + outNot reported
05

Skilled care at home

Home health

In-network$0 cost share
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premium$145 / month
Consolidated C + DNot reported

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-networkPrimary Care Physician Services: $0–$15 copay
Out-of-networkNot separately reported

Specialist

In-networkPhysician Specialist Services: $0–$15 copay
Out-of-networkNot separately reported

Preventive care

In-networkAnnual Physical Exam: $0 cost share; Kidney Disease Education Services: $0 cost share; Glaucoma Screening: $0 cost share; Diabetes Self-Management Training: $0 cost share; Digital Rectal Exams: $0 cost share; EKG following Welcome Visit: $0 cost share
Out-of-networkNot separately reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-networkDiagnostic Procedures/Tests: $0 cost share
Out-of-networkNot separately reported

Laboratory services

In-networkLab Services: $0 cost share
Out-of-networkNot separately reported

X-rays & standard imaging

In-networkOutpatient X-Ray Services: $10 copay
Out-of-networkNot separately reported

MRI, CT & PET imaging

In-networkDiagnostic Radiological Services: $0–$200 copay
Out-of-networkNot separately reported
Urgent & hospital care6 benefits

Urgent care

In-networkUrgently Needed Services: $15 copay
Out-of-networkNot separately reported

Emergency room

In-network$140 copay
Out-of-networkNot separately reported

Ground ambulance

In-network$100 copay
Out-of-networkNot separately reported

Air ambulance

In-network$100 copay
Out-of-networkNot separately reported

Outpatient hospital

In-networkOutpatient Hospital Services: $200 copay
Out-of-networkNot separately reported

Outpatient surgery / ASC

In-networkAmbulatory Surgical Center (ASC) Services: $200 copay
Out-of-networkNot separately reported
Recovery & therapy5 benefits

Home health

In-network$0 cost share
Out-of-networkNot separately reported

Skilled nursing facility

In-networkSkilled nursing facility: $0 cost share
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

In-networkCardiac Rehabilitation Services: $0 cost share; Intensive Cardiac Rehabilitation Services: $0 cost share; Pulmonary Rehabilitation Services: $0 cost share; SET for PAD Services: $0 cost share; 3-1(NMC): Not applicable; 3-2(NMC): Not applicable; 3-3(NMC): Not applicable; 3-4(NMC): Not applicable
Out-of-networkNot separately reported

Occupational therapy

In-networkOccupational Therapy Services: $15 copay
Out-of-networkNot separately reported

Physical & speech therapy

In-networkPhysical Therapy and Speech-Language Pathology Services: $15 copay
Out-of-networkNot separately reported
Behavioral health2 benefits

Mental health services

In-networkPartial Hospitalization Program: $0 cost share; Individual Sessions for Mental Health Specialty Services: $15 copay; Group Sessions for Mental Health Specialty Services: $7.50 copay; Individual Sessions for Psychiatric Services: $15 copay; Group Sessions for Psychiatric Services: $7.50 copay; Inpatient psychiatric hospital: Tier 1: $400 per stay
Out-of-networkNot separately reported

Substance use treatment

In-networkIntensive Outpatient Program Services: $0 cost share; Individual Sessions for Outpatient Substance Abuse: $15 copay; Group Sessions for Outpatient Substance Abuse: $15 copay
Out-of-networkNot separately reported
Specialty care2 benefits

Podiatry

In-networkPodiatry Services: $15 copay; 7f(NMC): Not applicable
Out-of-networkNot separately reported

Chiropractic

In-networkChiropractic Services: $15 copay
Out-of-networkNot separately reported
Supplemental benefits7 benefits

Dental

In-networkMedicare Dental Services: $0 cost share
Out-of-networkNot separately reported

Vision

In-networkEye Exams: $15 copay; Other Eye Exam Services: Not applicable; Eyewear: $0 cost share; Contact Lenses: Not applicable; Eyeglasses (lenses and frames): Not applicable; Eyeglass lenses: Not applicable; Eyeglass frames: Not applicable; Upgrades: Not applicable
Out-of-networkNot separately reported

Hearing

In-networkHearing Exams: $15 copay; Prescription Hearing Aids (all types): $499–$999 copay; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Out-of-networkNot separately reported

Transportation

Not applicable
In-network10b(NMC): Not applicable
Out-of-networkNot separately reported

Fitness & wellness

Not reported in this CMS export
In-networkNot separately reported
Out-of-networkNot separately reported

Over-the-counter allowance

Not applicable
In-networkOver-the-Counter (OTC) Items: Not applicable
Out-of-networkNot separately reported

Meals

Not applicable
In-networkMeal Benefit: Not applicable
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview

Premium & Part B giveback

$145 Part C premium / month · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-network$4,000
Combined in + outNot reported

Medical deductibles

In-network$0
Out-of-networkNot reported

Annual health deductible

Not separately reported

Combined network deductible

Not separately reported

Part D premium

Not reported

Network & referrals

1876 Cost · Referrals: Not required · Out-of-network coverage: Not reported

Prescription drugs0 tiers

Part D deductible

Not reported

Using this plan

Understand H2462-028-000

Plain-language context built from this plan’s 2027 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

HealthPartners Freedom Balance WI (Cost) is a 2027 1876 Cost offered by HealthPartners in Select Counties in Western WI. The plan record does not require referrals.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
Primary Care Physician Services: $0–$15 copay
Specialist
Physician Specialist Services: $0–$15 copay
Laboratory services
Lab Services: $0 cost share

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
Diagnostic Procedures/Tests: $0 cost share
MRI, CT & PET imaging
Diagnostic Radiological Services: $0–$200 copay
Outpatient hospital
Outpatient Hospital Services: $200 copay

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$140 copay

Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
Select Counties in Western WI (WI)
Plan type
1876 Cost
Contract / plan
H2462-028
Coverage year
2027

Enrollment generally requires Medicare eligibility and residence in the plan's service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

DentalMedicare Dental Services: $0 cost share
VisionEye Exams: $15 copay; Other Eye Exam Services: Not applicable; Eyewear: $0 cost share; Contact Lenses: Not applicable; Eyeglasses (lenses and frames): Not applicable; Eyeglass lenses: Not applicable; Eyeglass frames: Not applicable; Upgrades: Not applicable
HearingHearing Exams: $15 copay; Prescription Hearing Aids (all types): $499–$999 copay; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable

Plan-specific answers

Frequently asked questions

Where is H2462-028-000 available?

HealthPartners Freedom Balance WI (Cost) is listed for Select Counties in Western WI (WI). Enrollment generally requires Medicare eligibility and residence in the plan's service area.

What is the in-network maximum out-of-pocket limit for H2462-028-000?

The 2027 CMS record lists an in-network medical maximum out-of-pocket limit of $4,000. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H2462-028-000?

The listed Part C premium is $145 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H2462-028-000?

The plan record lists $140 copay, waived when an admission meets the plan's stated timing rule.

Does H2462-028-000 report extra benefits?

Yes. CMS reports dental, vision, hearing. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2027

Plan identity and benefits come from CMS PBP data. Benefits and drug cost sharing come from the approved annual PBP tabular extract and its CMS dictionary. Premiums and drug deductibles are cross-checked with the annual Landscape. Geography comes from annual PlanArea and PlanRegionArea records, including exact segments and partial-county or employer/group qualifiers. Quick-reference values should be confirmed in current official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H2462-028-000 fits

Full CMS plan ID
H2462-028-000
Contract
H2462
Base plan code
H2462-028
Segment
000
Carrier
HealthPartners
Plan type
1876 Cost
Service area
Select Counties in Western WI (WI)

County/service-area foundation

CMS service-area entries

Service areas come from the annual CMS PlanArea and PlanRegionArea tables for this exact contract, plan, and segment. Partial-county and employer/group qualifiers remain part of the coverage area. Regional PPO county entries use the matching annual Landscape expansion of the CMS region.

  • Burnett, WI
  • Douglas, WI
  • Dunn, WI
  • Pierce, WI
  • Polk, WI
  • St. Croix, WI
  • Washburn, WI

Exact county navigation

These links are limited to named counties tied to this exact medical plan segment. Partial-county entries remain labeled for verification.

Show 7 county links

Same CMS contract

H2462-026-000 HealthPartners Freedom Basic WI (Cost) Select Counties in Western WI · 1876 Cost H2462-027-000 HealthPartners Freedom Vital WI (Cost) Select Counties in Western WI · 1876 Cost

About this code

What H2462-028-000 identifies

H2462-028-000 is a Contract Year 2027 Medicare plan segment code. Searches written as H2462-028, H2462 028, or the compact full CMS ID H2462028000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.