Gundersen Senior Preferred Value (no Rx) (HMO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by Senior Preferred
Additional Coverage
Hearing Vision
Overall Government Star Rating
 5.0
out of 5 stars

State: Wisconsin

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B

 

$20
$20
$0
$0
$3,400 In-network
No
Yes
Yes
No

Medical Benefits

Doctor Services

$25 per visit
$25 per visit

Tests, labs, & imaging

10%
10%
10%
10%
$100 per visit (always covered)
$25 per visit (always covered)

Hospital Services

$200 per day for days 1 through 8
$0 per day for days 9 through 90
$0-100 per visit

Skilled nursing facility

$0 per day for days 1 through 20
$125 per day for days 21 through 100

Preventive services

$0 copay

Ambulance

$150

Therapy services

$25
$25

Mental health services

$25
$25
$25
$25

Opioid treatment services

Covered

Other services

20% per item
20% per item
0-25% per item

Prescription Drug Benefits

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

Part B Drugs

20%
20%

Extra Benefits

Hearing

$15
Not covered
$675-2,025

Preventive Dental

Not covered
Not covered
Not covered
Not covered

Comprehensive dental

Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered

Vision

$0-25
Not covered
$0 copay
$0 copay
$0 copay
$0 copay

Other benefits

Not covered
Limited coverage
Not covered
Not covered
Not covered
Limited coverage
Not covered
 4.5
 5
 4
 5
 4
 4

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