Network Health Cares (PPO D-SNP)
Wisconsin Medicare-Medicaid Dual Eligible D-SNP Plan (2025 Plan)
by Network Health Medicare Advantage Plans
Additional Coverage
HearingVisionDental
Overall Government Star Rating
5.0
out of 5 stars
Plan Name
Network Health Cares (PPO D-SNP)
Insurance Carrier
Network Health Medicare Advantage Plans
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
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.
Annual Deductible
Coming soon
Primary doctor visit
0% or 20% coinsurance per visit
Specialist visit
0% or 20% coinsurance per visit
ER visit
0% or 20% coinsurance per visit (always covered)
Ambulance
0% or 20% coinsurance
Network Health Cares (PPO D-SNP) has a monthly premium cost of $44 per month, with an annual deductible of Coming soon 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.
Yes
Part D Prescription Drug 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
Over the counter drug benefits
Home and bathroom safety devices
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 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 3.8 stars.
This Plan’s 5-star Gov’t Quality Score
Wisconsin State Average Score
Overall Government 5 Star Quality Rating
5.0
3.8
Summary rating of health plan quality
Staying healthy: screenings, tests, & vaccines
Managing chronic (long term) conditions
Member experience with health plan
Member complaints & changes in the health plan's performance
Health plan customer service
Summary rating of drug plan quality
Drug plan customer service
Member complaints & changes in the drug plan's performance
Member experience with the drug plan
Drug safety & accuracy of drug pricing
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 3.6 stars.
Network Health Cares (PPO D-SNP) received 5 stars for its drug plan quality score which is better than the Wisconsin State average drug plan quality score of 3.5 stars.
Health Portion of Premium
Health Plan Max Out-of-Pocket
$12,450 In and Out-of-network
$8,300 In-network
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
In-network: 0% or 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Specialist visit
In-network: 0% or 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Lab services
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Diagnostic radiology services (like MRI)
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient x-rays
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Emergency care
0% or 20% coinsurance per visit (always covered)
Urgent care
0% or 20% coinsurance per visit (always covered)
Hospital Services
Inpatient hospital coverage
In-network: Coming soon
Out-of-network: Coming soon
Outpatient hospital coverage
In-network: 0% or 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Skilled nursing facility
Skilled nursing facility
In-network: Coming soon
Out-of-network: Coming soon
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: 20% coinsurance
Ambulance
Ground ambulance
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Therapy services
Occupational therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Physical therapy & speech & language therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Mental health services
Outpatient group therapy with a psychiatrist
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient group therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 0% or 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 0% or 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Diabetes supplies
In-network: 0% or 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Catastrophic coverage phase |
|---|
| Preferred Generic |
Generic drugs :
25% coinsurance Brand-name drugs :
25% coinsurance |
Generic drugs :
0% coinsurance Brand-name drugs :
0% coinsurance |
| Generic |
| Preferred Brand |
| Non-Preferred Drug |
| Specialty Tier |
Part B Drugs
Chemotherapy drugs
In-network: 0% or 0-20% coinsurance
Out-of-network: 0-20% coinsurance
Other Part B drugs
In-network: 0% or 0-20% coinsurance
Out-of-network: 0-20% coinsurance
Hearing
Hearing exam
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
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: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Restorative services
In-network: $0 copay
Out-of-network: 0%-50% coinsurance
Endodontics
In-network: $0 copay
Out-of-network: 50% coinsurance
Periodontics
In-network: $0 copay
Out-of-network: 50% coinsurance
Prosthodontics, removable
In-network: $0 copay
Out-of-network: 50% coinsurance
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: 50% coinsurance
Maxillofacial prosthetics
In-network: $0 copay
Out-of-network: 50% coinsurance
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: 0%-50% coinsurance
Adjunctive general services
In-network: $0 copay
Out-of-network: 50% coinsurance
Vision
Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay
Upgrades
In-network: $0 copay
Out-of-network: $0 copay
When Can I Sign Up for Medicare?
Enter your birthday month and year to learn when you can sign up for different Medicare plan options.
Health Plan Radar