Network Health Cares (PPO D-SNP)
Wisconsin Medicare-Medicaid Dual Eligible D-SNP Plan (2024 Plan)
Monthly Premium
Additional Coverage
Overall Government Star Rating
5.0Ready to Enroll Online?
Plan Overview
Network Health Cares (PPO 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 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
Network Health Cares (PPO D-SNP) has a monthly premium cost of $48 per month, with an annual deductible of $0 or $1,632 per year for inpatient hospital services and $0 or $240 for outpatient services with a total plan deductible of $0 or $1,872 per year from in-network and out-of-network providers. and a maximum out of pocket cost sharing of $12,450 In and Out-of-network $8,300 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 Cares (PPO D-SNP) are defined below.
Additional Benefits and Coverage
Network Health Cares (PPO 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. Network Health Cares (PPO D-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Network Health Cares (PPO D-SNP) includes coverage for the following additional benefits:
Other benefits
Comparing the Quality Score of Network Health Cares (PPO D-SNP) 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 2024, Network Health Cares (PPO D-SNP) received an overall government quality rating of 5.0 stars out of 5 stars.
Network Health Cares (PPO D-SNP) performed better than Wisconsin’s State average overall quality score of 4.0 stars.
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 Cares (PPO D-SNP) received 5 stars for its health plan quality score which is better than the Wisconsin State average health plan quality score of 3.9 stars.
Network Health Cares (PPO 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.
Plan Benefits and Coverage Details
$8,300 In-network
Medical Benefits
Doctor Services
Out-of-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Tests, labs, & imaging
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Hospital Services
$1,632 deductible for days 1 through 60
$408 copay per day for days 61 through 90
Out-of-network: In 2024 the amounts for each benefit period are:
$1,632 deductible for days 1 through 60
$408 copay per day for days 61 through 90
Out-of-network: 20% coinsurance per visit
Skilled nursing facility
$0 copay for days 1 through 20
$204 copay per day for days 21 through 100
Out-of-network: In 2024 the amounts for each benefit period are:
$0 copay for days 1 through 20
$204 copay per day for days 21 through 100
Preventive services
Out-of-network: 20% coinsurance
Ambulance
Out-of-network: 20% coinsurance
Therapy services
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Mental health services
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Opioid treatment services
Other services
Out-of-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic | $15.00 copay |
Brand-name drugs :
|
Brand-name drugs :
|
| Generic | $20.00 copay | ||
| Preferred Brand | $47.00 copay | ||
| Non-Preferred Drug | $100.00 copay | ||
| Specialty Tier | 25% |
Part B Drugs
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Extra Benefits
Hearing
Out-of-network: 20% coinsurance
Out-of-network: $40 copay
Out-of-network: $495-1,695 copay
Preventive Dental
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Out-of-network: 0-50% coinsurance
Out-of-network: 0-50% coinsurance
Out-of-network: 0-50% coinsurance
Out-of-network: 0-50% coinsurance
Out-of-network: 0-50% coinsurance
Vision
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
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