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My Choice Wisconsin Partnership Plan (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for My Choice Wisconsin Partnership Plan (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on My Choice Wisconsin Partnership Plan (HMO D-SNP) in 2025, please refer to our full plan details page.
My Choice Wisconsin Partnership Plan (HMO D-SNP) is a HMO D-SNP plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Southcentral and Eastern Wisconsin. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that My Choice Wisconsin Partnership Plan (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
My Choice Wisconsin Partnership Plan (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about My Choice Wisconsin Partnership Plan (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For My Choice Wisconsin Partnership Plan (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.40. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The My Choice Wisconsin Partnership Plan (HMO D-SNP) has a deductible of $590.00. After the deductible, you will pay the costs for your drugs based on the tier. The plan's premium may be reduced if you qualify for the low-income subsidy (LIS). After your yearly out-of-pocket drug costs reach $2000.00, you will pay nothing for your Part D covered drugs. Please check the plan's formulary for the specific drugs covered.
Additional Benefits
The My Choice Wisconsin Partnership Plan (HMO D-SNP) offers a wide range of benefits, including coverage for inpatient and outpatient services, with varying coinsurance rates. Many services, like primary care, hearing, and vision, are covered, with copays or coinsurance requirements. The plan also includes dental, home infusion, and medical equipment coverage. Preventive services have no copay, and other services, such as ambulance and emergency services, are covered with a 20% coinsurance. The plan covers a range of services, but some, such as additional days in a skilled nursing facility or personal care services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered and require prior authorization, with cost sharing determined by Medicare. However, additional days, non-Medicare-covered stays, and upgrades for Acute and Psychiatric services are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have a 20% coinsurance after the deductible is met. Individual and group sessions for outpatient substance abuse have a minimum coinsurance of 20% and a maximum coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the My Choice Wisconsin Partnership Plan (HMO D-SNP) with a 20% coinsurance. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground and air ambulance services, each with a 20% coinsurance, as well as transportation services to any health-related location.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the My Choice Wisconsin Partnership Plan (HMO D-SNP). For Emergency Services and Urgently Needed Services, there is a 20% coinsurance, but no copay. Worldwide Emergency Services has a maximum plan benefit coverage of $10,000.
Primary Care See details
The My Choice Wisconsin Partnership Plan (HMO D-SNP) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, and speech-language pathology services have a 20% coinsurance. Occupational therapy services, individual and group sessions for mental health specialty services, individual and group sessions for psychiatric services, and opioid treatment program services have a minimum and maximum coinsurance of 20%.
Preventive Services See details
The My Choice Wisconsin Partnership Plan (HMO D-SNP) covers a range of preventive services, including no copay for Medicare-covered preventive services, and also covers an annual physical exam. Additional preventive services, including health education, personal emergency response systems, nutritional/dietary benefits (up to 12 visits), and additional smoking cessation counseling (up to 8 visits), are covered. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered with 20% coinsurance.
Hearing Services See details
Hearing services are covered, including routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have a coinsurance of at most 20%, and are limited to 1 visit per year. Prescription hearing aids are limited to 2 every two years, and OTC hearing aids are limited to 2 every two years. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include routine eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear, including contact lenses, has a 20% coinsurance, and there is a combined maximum of $300 per year.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other Dental Services include oral exams (2 per year), dental X-rays (1), prophylaxis (cleaning) (2 per year), and fluoride treatment (2 per year), and orthodontic services with a $3,600 maximum benefit. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, and Oral and Maxillofacial Surgery are covered, but require prior authorization. Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the My Choice Wisconsin Partnership Plan (HMO D-SNP). There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Diabetic Supplies and Therapeutic Shoes/Inserts; however, Durable Medical Equipment for use outside the home and Medical Supplies are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the My Choice Wisconsin Partnership Plan (HMO D-SNP). Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while all other diagnostic and radiological services have no copay.
Home Health Services See details
Home Health Services are covered by the My Choice Wisconsin Partnership Plan (HMO D-SNP) with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization is required, and the copay information is provided separately.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, but acupuncture, meal benefits, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Over-the-Counter (OTC) Items include Nicotine Replacement Therapy (NRT) and Naloxone.
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