My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)

Wisconsin Medicare-Medicaid Dual Eligible D-SNP Plan (2024 Plan)


Monthly Premium

Your Cost
$0
by My Choice Wisconsin Health Plan

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 4.0
out of 5 stars

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Plan Name
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
Insurance Carrier
My Choice Wisconsin Health Plan
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
HMO

My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Wisconsin and offered by the health insurance company My Choice Wisconsin Health Plan. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$8,850
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$0 copay
Ambulance
$0 copay

My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $8,850 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Not covered
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Limited coverage
Meals for short duration
Not covered
Annual physical exams
Not covered
Telehealth
Not covered

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) received an overall government quality rating of 4.0 stars out of 5 stars.

My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) performed the same as Wisconsin’s State average overall quality score of 4.0 stars.

This Plan’s 5-star Gov’t Quality Score
Wisconsin State Average Score
Overall Government 5 Star Quality Rating
 4.0
 4.0
Summary rating of health plan quality
 3.5
 3.9
Staying healthy: screenings, tests, & vaccines
 4
 3.6
Managing chronic (long term) conditions
 4
 3.5
Member experience with health plan
 3
 4.2
Member complaints & changes in the health plan's performance
 4
 3.6
Health plan customer service
 3
 4.0
Summary rating of drug plan quality
 4.5
 3.6
Drug plan customer service
 2
 3.5
Member complaints & changes in the drug plan's performance
 4
 3.7
Member experience with the drug plan
 4
 4.0
Drug safety & accuracy of drug pricing
 4
 3.3

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) received 3.5 stars for its health plan quality score which is worse than the Wisconsin State average health plan quality score of 3.9 stars.

My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) received 4.5 stars for its drug plan quality score which is better than the Wisconsin State average drug plan quality score of 3.6 stars.


Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$8,850 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$0 copay

Tests, labs, & imaging

Diagnostic tests & procedures
$0 copay
Lab services
$0 copay
Diagnostic radiology services (like MRI)
$0 copay
Outpatient x-rays
$0 copay
Emergency care
$0 copay
Urgent care
$0 copay

Hospital Services

Inpatient hospital coverage
$0 copay
Outpatient hospital coverage
$0 copay

Skilled nursing facility

Skilled nursing facility
$0 copay

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$0 copay

Therapy services

Occupational therapy visit
$0 copay
Physical therapy & speech & language therapy visit
$0 copay

Mental health services

Outpatient group therapy with a psychiatrist
$0 copay
Outpatient individual therapy with a psychiatrist
$0 copay
Outpatient group therapy visit
$0 copay
Outpatient individual therapy visit
$0 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
$0 copay
Prosthetics (like braces, artificial limbs)
$0 copay
Diabetes supplies
$0 copay

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

Chemotherapy drugs
$0 copay
Other Part B drugs
$0 copay

Hearing

Hearing exam
$0 copay
Fitting/evaluation
Not covered
Hearing aids - Inner ear
Not covered
Hearing aids - Outer ear
Not covered
Hearing aids - Over the ear
Not covered

Preventive Dental

Oral exam
20% coinsurance
Cleaning
20% coinsurance
Fluoride treatment
Not covered
Dental x-rays
20% coinsurance

Comprehensive dental

Non-routine services
Not covered
Diagnostic services
20% coinsurance
Restorative services
20% coinsurance
Endodontics
Not covered
Periodontics
Not covered
Extractions
20% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services
20% coinsurance

Vision

Routine eye exam
Not covered
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
$0 copay

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