Gundersen Quartz Med Advantage Elite (HMO)
Wisconsin Medicare Advantage Plan (2026 Plan)
by Quartz Medicare Advantage (HMO)
Additional Coverage
HearingVisionDental
Overall Government Star Rating
4.0
out of 5 stars
Plan Name
Gundersen Quartz Med Advantage Elite (HMO)
Insurance Carrier
Quartz Medicare Advantage (HMO)
Plan Type
Medicare Advantage Plan Without Prescription Drugs
Gundersen Quartz Med Advantage Elite (HMO) is a Medicare Advantage Plan Without Prescription Drugs, which is available in Wisconsin and offered by the health insurance company Quartz Medicare Advantage (HMO). This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Primary doctor visit
$10 copay
Specialist visit
$45 copay
Gundersen Quartz Med Advantage Elite (HMO) has a monthly premium cost of $130 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $3,500 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 Gundersen Quartz Med Advantage Elite (HMO) are defined below.
No
Part D Prescription Drug Coverage
Gundersen Quartz Med Advantage Elite (HMO) is a Medicare Advantage plan which does not include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Gundersen Quartz Med Advantage Elite (HMO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Gundersen Quartz Med Advantage Elite (HMO) 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 2026, Gundersen Quartz Med Advantage Elite (HMO) received an overall government quality rating of 4.0 stars out of 5 stars.
Gundersen Quartz Med Advantage Elite (HMO) 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
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
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.
Gundersen Quartz Med Advantage Elite (HMO) received 4 stars for its health plan quality score which is the same as the Wisconsin State average health plan quality score of 4.0 stars.
Health Portion of Premium
Health Plan Max Out-of-Pocket
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
In-network: $10 copay
Out-of-network: $10 copay
Specialist visit
In-network: $45 copay
Out-of-network: $45 copay
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: $10 copay
Out-of-network: $10 copay
Lab services
In-network: $10 copay
Out-of-network: $10 copay
Diagnostic radiology services (like MRI)
In-network: $100 copay
Out-of-network: $100 copay
Outpatient x-rays
In-network: $10 copay
Out-of-network: $10 copay
Emergency care
In-network: No Data
Out-of-network: No Data
Urgent care
In-network: No Data
Out-of-network: No Data
Hospital Services
Inpatient hospital coverage
In-network: No Data
Out-of-network: No Data
Outpatient hospital coverage
In-network: $0-$150 copay
Out-of-network: $0-$150 copay
Skilled nursing facility
Skilled nursing facility
In-network: No Data
Out-of-network: No Data
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance
In-network: $300 copay
Out-of-network: $300 copay
Therapy services
Occupational therapy visit
In-network: $15 copay
Out-of-network: $15 copay
Physical therapy & speech & language therapy visit
In-network: $15 copay
Out-of-network: $15 copay
Mental health services
Outpatient group therapy with a psychiatrist
In-network: $35 copay
Out-of-network: $35 copay
Outpatient individual therapy with a psychiatrist
In-network: $35 copay
Out-of-network: $35 copay
Outpatient group therapy visit
In-network: $35 copay
Out-of-network: $35 copay
Outpatient individual therapy visit
In-network: $35 copay
Out-of-network: $35 copay
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Diabetes supplies
In-network: $0 copay
Out-of-network: $0 copay
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
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
Hearing
Hearing exam
In-network: $25 copay
Out-of-network: $25 copay
Hearing aids - prescription
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - over the counter
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 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Prosthodontics, fixed
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Maxillofacial prosthetics
Implant services
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay
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
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: $0 copay
Upgrades
In-network: $0 copay
Out-of-network: $0 copay
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