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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 2026, 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 2026 to people living in Select counties in WI. This plan received an overall rating of 3 out of 5 stars in 2026.
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 $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 $615.00 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 $9250.00 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:
Sign up for My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)
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Drug Coverage
The My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) has an annual prescription drug deductible of $615. For cost savings, this plan offers no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This no-copay benefit applies to one-month, two-month, and three-month supplies. For other medication tiers, your costs are determined by coinsurance at standard pharmacies and standard mail order. You will pay a 15% coinsurance for Tier 2 generic drugs, a 20% coinsurance for Tier 3 preferred brand drugs, and a 30% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs require a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) offers comprehensive medical coverage with no copays for nearly all services, though coinsurance applies to several benefits. Essential services like inpatient hospital stays, skilled nursing facility care, and home health services are fully covered with no copay and no coinsurance. For outpatient care, emergency visits, and primary or specialist doctor appointments, members will pay no copay but are responsible for a 20% to 30% coinsurance. Supplemental benefits are also highly accessible, featuring no copays across dental, vision, hearing, and transportation services. Preventive and comprehensive dental care is covered with no copay or coinsurance up to a generous $4,000 annual limit, while routine vision and hearing exams generally carry a 20% coinsurance. Additionally, the plan provides over-the-counter items, meal benefits, and unlimited transportation to plan-approved health locations with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) covers outpatient services with no copay and a 20% coinsurance for outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services, with the cost waived for the first three pints.
Partial Hospitalization See details
Partial hospitalization is covered under the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) with no copay and a 30% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) covers ambulance services with a 20% coinsurance and no copay for both ground and air transport. Transportation services are partially covered, offering unlimited one-way trips to plan-approved health-related locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) covers emergency services with a 30% coinsurance and no copay, which is waived if admitted to the hospital within 24 hours, and urgent care with a 30% coinsurance and no copay. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance up to a $10,000 maximum benefit.
Primary Care See details
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) covers primary care, specialist, and therapy services with no copay and a 30% coinsurance. While telehealth and opioid treatment services require a 20% to 30% coinsurance, podiatry services are not covered and chiropractic benefits are only partially covered, excluding non-routine chiropractic care.
Preventive Services See details
Preventive services are partially covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP), with an annual physical, health education, fitness benefits, and select counseling sessions available with no copay and no coinsurance. Kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, and post-welcome visit EKGs are covered with no copay and a 20% coinsurance. Uncovered sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) covers hearing services, offering routine hearing exams with no copay and a 20% coinsurance, and fitting evaluations with no copay and no coinsurance. OTC and prescription hearing aids are covered with no copay and no coinsurance, although inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP), offering one routine eye exam per year and eyewear with no copay and a 20% coinsurance for routine exams and contact lenses. Other eye exam services are not covered, and eyewear benefits have a combined maximum coverage of $350 per year.
Dental Services See details
Dental services are partially covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP), featuring no copay and a 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services up to a $4,000 annual limit. Uncovered sub-services include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and between no coinsurance and 20% coinsurance, while Part B insulin drugs have a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and coverage may be limited to preferred vendors or manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. This coverage includes diagnostic tests, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home health services are covered under the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) with no copay and prior authorization required, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) with no copay and no coinsurance, as additional days beyond the Medicare-covered limit are not covered. Prior authorization is required for these services, though a prior three-day inpatient hospital stay is not required for admission.
Other Services See details
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Acupuncture is not covered, and prior authorization is required for the meal benefit.
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