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My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for My Choice Wisconsin Medicare Dual Advantage 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 Medicare Dual Advantage Plan (HMO D-SNP) in 2025, please refer to our full plan details page.
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) is a HMO D-SNP plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Southern, Central 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 Medicare Dual Advantage 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 Medicare Dual Advantage 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 Medicare Dual Advantage 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 Medicare Dual Advantage Plan (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.00. 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 Medicare Dual Advantage Plan (HMO D-SNP) has a $590 deductible for prescription drugs. After meeting the deductible, the plan covers drugs, but the specific costs for each tier are not listed in the provided information. If you qualify for the low-income subsidy (LIS), you will pay $4.00 for Part D drugs. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) offers coverage for a wide range of services with varying cost-sharing. Many services have a 20% coinsurance, including outpatient, primary care, ambulance, and dental services, as well as medical equipment and vision eyewear. There is no copay for many preventative services, like routine eye exams, and no copay for home health services, and OTC items.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days for inpatient hospital, non-Medicare-covered stays, and upgrades are not covered. You will have a copay for inpatient hospital acute and psychiatric care, but the exact amount is not specified.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Outpatient Blood Services also has a 20% coinsurance. Individual and Group Sessions for Outpatient Substance Abuse have a minimum and maximum coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) and requires prior authorization, with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a 20% coinsurance for both ground and air ambulance services. Transportation Services to any health-related location are covered, but transportation services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP). Emergency Services and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services has a maximum benefit coverage of $10,000.
Primary Care See details
The My Choice Wisconsin Medicare Dual Advantage 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 services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician, chiropractic, physician specialist, physical therapy and speech-language pathology services have a 20% coinsurance, and occupational therapy, mental health specialty, other health care professional, psychiatric, and opioid treatment program services have a minimum of 20% and a maximum of 20% coinsurance.
Preventive Services See details
Preventive services are covered, including annual physical exams, additional preventive services, and kidney disease education services. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have a 20% coinsurance. Health education, personal emergency response systems (PERS), additional sessions of smoking and tobacco cessation counseling, fitness benefits, and nutritional/dietary benefits are also covered. In-home safety assessments, medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services are covered, including routine hearing exams with a coinsurance of at most 20% and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. You can get one routine eye exam every year with no copay. Eyewear, including contact lenses, eyeglasses, lenses, and frames, is covered with a 20% coinsurance, and has a combined maximum benefit of $200 per year.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare Dental Services. Other dental services include oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, and oral and maxillofacial surgery, but maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis services are covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP). You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts each have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the My Choice Wisconsin Medicare Dual Advantage Plan, with no copay. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) with no copay or coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not provide SNF services as a supplemental benefit. The plan uses the original Medicare cost-sharing for tier 1 SNF services. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, with no copay and no coinsurance, and Meal Benefit with prior authorization required. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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