Special Needs Plan (Medicare Advantage) · HMO D-SNP · Plan ID H5262-029
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP)
Offered by Quartz Medicare Advantage (HMO) (University of Wisconsin Hospitals and Clincs Autho) · available in 1 county in WI
Only for people who have both Medicare and Medicaid.
Monthly premium$6.30health + drug coverage
Yearly out-of-pocket max$9,850in network
Drug deductible$700Actuarially Equivalent Standard
Star Rating★★★★ 4 out of 52027 CMS rating
Extra benefits listed in the CMS file
| Dental | Preventive and comprehensive dental |
|---|---|
| Vision | routine eye exam; eyewear |
| Hearing | routine hearing exam; hearing aids, plan pays up to $3,000 every 2 years |
| Over-the-counter items | $325 per quarter allowance |
| Fitness | Fitness benefit (gym membership or program) |
| Transportation | Rides to health-related locations |
| Personal emergency response system | Medical alert device or service |
Allowances and limits come from the plan's filing with CMS and are simplified here. Some benefits are only for members with certain chronic conditions. The plan's Evidence of Coverage is the final word.
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