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Network Health PremierRx (PPO)

Wisconsin Medicare Advantage Plan (2025 Plan)

Monthly Premium

Your Cost
$226
by Network Health Medicare Advantage Plans

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 5.0
out of 5 stars

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Plan Overview

Plan Name
Network Health PremierRx (PPO)
Insurance Carrier
Network Health Medicare Advantage Plans
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
PPO

Network Health PremierRx (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Wisconsin and offered by the health insurance company Network Health Medicare Advantage Plans. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.

Cost Summary

Monthly Premium
$226
Annual Deductible
$0
Max Out-of-Pocket
$3,400
Primary doctor visit
$10 copay per visit
Specialist visit
$20 copay per visit
ER visit
$125 copay per visit (always covered)
Ambulance
$0 copay

Network Health PremierRx (PPO) has a monthly premium cost of $226 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $3,400 In and Out-of-network $3,400 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 Network Health PremierRx (PPO) are defined below.

Additional Benefits and Coverage

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

Network Health PremierRx (PPO) 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. Network Health PremierRx (PPO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Network Health PremierRx (PPO) includes coverage for the following additional benefits:

Other benefits

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

Comparing the Quality Score of Network Health PremierRx (PPO) to Other Plans in Wisconsin

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 2025, Network Health PremierRx (PPO) received an overall government quality rating of 5.0 stars out of 5 stars.

Network Health PremierRx (PPO) performed better than Wisconsin’s State average overall quality score of 4.1 stars.

This Plan’s 5-star Gov’t Quality Score
Wisconsin State Average Score
Overall Government 5 Star Quality Rating
 5.0
 4.1
Summary rating of health plan quality
 5
 4.0
Staying healthy: screenings, tests, & vaccines
 4
 4.0
Managing chronic (long term) conditions
 4
 3.4
Member experience with health plan
 5
 4.0
Member complaints & changes in the health plan's performance
 5
 4.4
Health plan customer service
 4
 3.9
Summary rating of drug plan quality
 5
 4.0
Drug plan customer service
 4
 4.0
Member complaints & changes in the drug plan's performance
 5
 4.2
Member experience with the drug plan
 5
 3.7
Drug safety & accuracy of drug pricing
 4
 3.5

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.

Network Health PremierRx (PPO) received 5 stars for its health plan quality score which is better than the Wisconsin State average health plan quality score of 4.0 stars.

Network Health PremierRx (PPO) received 5 stars for its drug plan quality score which is better than the Wisconsin State average drug plan quality score of 4.0 stars.

Plan Benefits and Coverage Details

Monthly Premium
$226
Health Portion of Premium
$93
Drug Portion of Premium
$133
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$3,400 In and Out-of-network
$3,400 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link
https://networkhealth.com/find-a-doctor/
Plan Link
https://networkhealth.com/

Medical Benefits

Doctor Services

Primary doctor visit
In-network: $10 copay per visit
Out-of-network: $10 copay per visit
Specialist visit
In-network: $20 copay per visit
Out-of-network: $20 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0 copay
Out-of-network: $0 copay
Lab services
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: $0 copay
Out-of-network: $0 copay
Outpatient x-rays
In-network: $0 copay
Out-of-network: $0 copay
Emergency care
$125 copay per visit (always covered)
Urgent care
$20 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $75 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: $75 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
In-network: $0 copay
Out-of-network: $0 copay

Skilled nursing facility

Skilled nursing facility
In-network: $0 copay
Out-of-network: $0 per day for days 1 through 100

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance
In-network: $0 copay
Out-of-network: $0 copay

Therapy services

Occupational therapy visit
In-network: $20 copay
Out-of-network: $20 copay
Physical therapy & speech & language therapy visit
In-network: $20 copay
Out-of-network: $20 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $0 copay
Out-of-network: $0 copay
Outpatient individual therapy with a psychiatrist
In-network: $0 copay
Out-of-network: $0 copay
Outpatient group therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Outpatient individual therapy visit
In-network: $0 copay
Out-of-network: $0 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: $0 copay
Out-of-network: $0 copay
Prosthetics (like braces, artificial limbs)
In-network: $0 copay
Out-of-network: $0 copay
Diabetes supplies
In-network: $0 copay
Out-of-network: $0 copay

Prescription Drug Benefits

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

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic$7.00 copay$0 copay
Generic$15.00 copay$0 copay
Preferred Brand22% coinsurance$0 copay
Non-Preferred Drug45% coinsurance$0 copay
Specialty Tier29% coinsurance$0 copay

Part B Drugs

Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: 0-20% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 0-20% coinsurance

Extra Benefits

Hearing

Hearing exam
In-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - All types
In-network: $495-1,695 copay
Out-of-network: $495-1,695 copay

Preventive Dental

Oral exam
In-network: $30 copay
Out-of-network: $0 copay
Cleaning
In-network: $30 copay
Out-of-network: $0 copay
Fluoride treatment
Not covered
Dental x-rays
Not covered

Comprehensive dental

Restorative services
Not covered
Endodontics
Not covered
Periodontics
Not covered
Prosthodontics, removable
Not covered
Prosthodontics, fixed
Not covered
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
Not covered
Orthodontics
Not covered
Adjunctive general services
Not covered

Vision

Routine eye exam
In-network: $10 copay
Out-of-network: $0 copay
Contact lenses
Not covered
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

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