2025
SmartPlan (Cost)
- 2025 - Iowa/Illinois - $131
- 2025 - Wisconsin - $139
In Network:
- MAHP Network (Medical Associates Clinics and outlying primary care physicians)
- No deductibles or copayments
- Referral: Iowa City/Madison
- Emergency Coverage Worldwide
Out of Network:
- Original Medicare Cost Sharing
Provider Directory
SmartPlan Provider Directory
2025 Summary of Benefits
Iowa SmartPlan SB [PDF]
Illinois SmartPlan SB [PDF]
Wisconsin SmartPlan SB [PDF]
2025 - Evidence of Coverage
Iowa SmartPlan EOC [PDF]
Illinois SmartPlan EOC [PDF]
Wisconsin SmartPlan EOC [PDF]
2025 - Annual Notice of Change
Iowa SmartPlan ANOC [PDF]
Illinois SmartPlan ANOC [PDF]
Wisconsin SmartPlan ANOC [PDF]
2025 Enrollment Applications
Iowa [PDF]
Illinois [PDF]
Wisconsin [PDF]
2024
SmartPlan (Cost)
- 2024 - Iowa/Illinois - $128
- 2024 - Wisconsin - $136
2024 Summary of Benefits
Iowa SmartPlan SB [PDF]
Illinois SmartPlan SB [PDF]
Wisconsin SmartPlan SB [PDF]
2024 - Evidence of Coverage
Iowa SmartPlan EOC [PDF]
Illinois SmartPlan EOC [PDF]
Wisconsin SmartPlan EOC [PDF]
2024 - Annual Notice of Change
Iowa SmartPlan ANOC [PDF]
Illinois SmartPlan ANOC [PDF]
Wisconsin SmartPlan ANOC [PDF]
2024 Enrollment Applications
Iowa [PDF]
Illinois [PDF]
Wisconsin [PDF]
2025
Freedom Plan (Cost)
- 2025 Iowa/Illinois - $203
- 2025 Wisconsin - $213
In Network:
- MAHP Network (Medical Associates Clinics and outlying primary care physicians); and
- Tri-State Docs
- No deductibles or copayments
- Referral: Iowa City/Madison
- Emergency Coverage Worldwide
Out of Network:
- Any doctor/provider in the United States who will see Medicare beneficiaries for Medicare eligible services
- Copayments
- $25.00 copay per physician office visit
- $25.00 copay per outpatient rehabilitation visit (physical, speech, occupational)
- Lesser of Medicare allowable charge or $500 copay per outpatient surgery (same day surgery) done at an Ambulatory Surgical Center or Outpatient Hospital. Cost sharing applicable to facility charges.
- $500 copay per inpatient admission per benefit period
- $100.00 copay per test/image in an outpatient setting (infusion, CT scan, PET scan and MRI/MRA)
Out of Network Medicare eligible services covered up to Medicare allowable. Part B excess charges apply.
Certain Medicare eligible services obtained out of network require a prior authorization regardless of referral status before getting the care/treatment and can be reviewed at www.mahealthcare.com/insurance/products-and-services/managed-care/health-care-services/utilization-management or call Member Services to find out if a prior authorization is required for the out of network care/treatment.
Provider Directory
Freedom Plan Provider Directory
2025 Summary of Benefits
Iowa SmartPlan SB [PDF]
Illinois SmartPlan SB [PDF]
Wisconsin SmartPlan SB [PDF]
2025 Evidence of Coverage
Iowa Freedom Plan EOC [PDF]
Illinois Freedom Plan EOC [PDF]
Wisconsin Freedom Plan EOC [PDF]
2025 Annual Notice of Change
Iowa Freedom Plan ANOC [PDF]
Illinois Freedom Plan ANOC [PDF]
Wisconsin Freedom Plan ANOC [PDF]
2025 Enrollment Applications
Iowa [PDF]
Illinois [PDF]
Wisconsin [PDF]
2024
Freedom Plan (Cost)
- 2023 Iowa/Illinois - $193
- 2023 Wisconsin - $203
2024 Summary of Benefits
Iowa SmartPlan SB [PDF]
Illinois SmartPlan SB [PDF]
Wisconsin SmartPlan SB [PDF]
2024 Evidence of Coverage
Iowa Freedom Plan EOC [PDF]
Illinois Freedom Plan EOC [PDF]
Wisconsin Freedom Plan EOC [PDF]
2024 Annual Notice of Change
Iowa Freedom Plan ANOC [PDF]
Illinois Freedom Plan ANOC [PDF]
Wisconsin Freedom Plan ANOC [PDF]
2024 Enrollment Applications
Iowa [PDF]
Illinois [PDF]
Wisconsin [PDF]
