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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) features an annual prescription drug deductible of $615. Beneficiaries pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard pharmacies or standard mail order. This zero-dollar coverage applies to one-month, two-month, and three-month supplies of these essential medications. For other drug tiers, coverage is based on coinsurance rather than flat copays. You will pay a 15% coinsurance for Tier 2 generic drugs, 20% coinsurance for Tier 3 preferred brand drugs, and 30% coinsurance for Tier 4 non-preferred drugs at standard pharmacies and standard mail order. 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 healthcare coverage with no copays for major services like inpatient hospital stays, skilled nursing facility care, and home health services. For outpatient care, primary visits, and specialist services, members also pay no copays, though coinsurance rates typically range from 20% to 30%. Emergency services and ambulance transportation are covered with no copay and a 20% to 30% coinsurance. This plan features robust supplemental benefits including dental, vision, and hearing care, which generally require no copays and either no coinsurance or a standard 20% coinsurance for routine services. Members also benefit from no copay and no coinsurance for unlimited transportation to approved medical locations, select meals, and over-the-counter items. Preventive care, diagnostic tests, and durable medical equipment are also highly accessible with no copayments and minimal coinsurance.
Inpatient Hospital See details
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, subject to prior authorization. Additional days, non-Medicare-covered stays, and acute care upgrades are not covered.
Outpatient Services See details
Outpatient services covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) feature no copays, but they require a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most outpatient care, and there is no deductible for blood services.
Partial Hospitalization See details
The My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP), with ground and air ambulance services requiring prior authorization and a 20% coinsurance with no copay. Transportation services are partially covered with no copay and no coinsurance for unlimited one-way trips to plan-approved health-related locations, but transportation to any health-related location is not covered.
Emergency Services See details
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) covers emergency and urgently needed services with a 30% coinsurance and no copay, with the emergency coinsurance waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum plan benefit of $10,000.
Primary Care See details
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 30% coinsurance, while telehealth and opioid treatment carry a 20% to 30% coinsurance. Podiatry services and non-routine chiropractic care are not covered under this plan, and prior authorization is required for several services.
Preventive Services See details
Preventive services are partially covered under the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP), with annual physicals and select wellness benefits costing no copay and no coinsurance, while kidney education and other screenings carry no copay and a 20% coinsurance. Sub-services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home/bathroom safety modifications, and counseling.
Hearing Services See details
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) covers hearing exams with no copay and no deductible, though routine exams require a 20% coinsurance. Hearing aids are partially covered with no copay and no coinsurance, including unlimited OTC devices and up to two prescription hearing aids every two years, but inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) with no copays or deductibles, though a 20% coinsurance applies to routine eye exams and contact lenses. One routine eye exam is covered per year, and there is a $350 annual combined maximum for eyewear, while other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP), offering Medicare-covered dental with no copay and a 20% coinsurance, and other covered dental services with no copay and no coinsurance. Sub-services that are not covered under this plan include other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have a 0% to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and 0% to 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 services with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and coverage may be limited to preferred vendors or specified 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 a 20% coinsurance and no copay, subject to prior authorization. This coverage applies to all diagnostic procedures, 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. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) with no copay and prior authorization required, but only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While the plan allows for admission without a prior three-day inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by the My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP), which offers over-the-counter (OTC) items and eligible meal benefits with no copay and no coinsurance. Acupuncture and other supplemental services are not covered under this benefit.
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