Gundersen Senior Preferred Core (w/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) with Prescription Drug (Part D)

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

 

$0
$0
$0
$0
$5,000 In-network
No
Yes
Yes
No

Medical Benefits

Doctor Services

$25 per visit
$50 per visit

Tests, labs, & imaging

20%
20%
20%
20%
$90 per visit (always covered)
$65 per visit (always covered)

Hospital Services

$270 per day for days 1 through 8
$0 per day for days 9 through 90
$0-350 per visit

Skilled nursing facility

$0 per day for days 1 through 20
$178 per day for days 21 through 100

Preventive services

$0 copay

Ambulance

$300

Therapy services

$40
$40

Mental health services

$40
$40
$40
$40

Opioid treatment services

Covered

Other services

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

Prescription Drug Benefits

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

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic$3.00 copay


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$3.60 copay or 5% (whichever costs more)

Brand-name drugs :
$8.95 copay or 5% (whichever costs more)

Generic$15.00 copay
Preferred Brand$45.00 copay
Non-Preferred Drug40%
Specialty Tier33%

Part B Drugs

20%
20%

Extra Benefits

Hearing

$25
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
 4.5
 5
 4
 5
 4

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