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Spirit (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Spirit (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Spirit (HMO-POS) in 2025, please refer to our full plan details page.
Spirit (HMO-POS) is a HMO-POS plan offered by Marshfield Clinic Health System, Inc. available for enrollment in 2025 to people living in Central, North, Northeast, West & South Central WI. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Spirit (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Spirit (HMO-POS).
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 Spirit (HMO-POS), 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.
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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $1500.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $1500.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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
Prescription drugs are not covered by Spirit (HMO-POS).
Additional Benefits
The Spirit (HMO-POS) plan provides coverage for a variety of healthcare services. Inpatient hospital stays have a $250 copay per stay, while outpatient services may have copays ranging from $0 to $100. Emergency services have a $125 copay, and primary care visits have copays between $20 and $25. Preventive services are covered with no copay, and hearing exams have a $25 copay. Vision services include eye exams with a $25 copay, and eyeglasses are covered with no copay. Dental services include oral exams and cleanings covered once per year. Other benefits include coverage for ambulance, home health services, skilled nursing facilities, and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with prior authorization required. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric stays, there is a $250 copay per stay, and additional days are covered for Inpatient Hospital-Acute with no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services, with a copay between $0 and $100, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $25 copay for both individual and group sessions, and Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Spirit (HMO-POS) plan. The plan covers the benefit, but does not provide any further details about the cost of the benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Spirit (HMO-POS) plan. Ground and Air Ambulance Services have a $175 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Spirit (HMO-POS) plan. Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a copay between $0 and $25 with no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a copay between $0 and $25, and Worldwide Emergency Transportation has a $175 copay; all have no coinsurance.
Primary Care See details
The Spirit (HMO-POS) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $25 copay, and mental health specialty services with a $25 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $20 copay, and additional telehealth benefits have a copay between $0 and $175. Opioid Treatment Program Services are covered with a 20% coinsurance and a copay between $0 and $25. Podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams, and additional preventive services that require prior authorization, as well as Health Education, In-Home Safety Assessment, Re-admission Prevention, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Home and Bathroom Safety Devices and Modifications have a 20% coinsurance. Services for Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, and Support for Caregivers of Enrollees are not covered. Counseling Services are also not covered.
Hearing Services See details
The Spirit (HMO-POS) plan covers hearing exams with a $25 copay, routine hearing exams (1 per year) with a $25 copay, and fitting/evaluation for hearing aids with a $25 copay. Prescription hearing aids (all types) are covered with a $500 copay, but prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams, with a $25 copay, and routine eye exams with no copay. Eyewear benefits include eyeglasses (lenses and frames) with no copay, and a combined maximum of $175 per year. Contact lenses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatment. Oral exams and cleanings are covered once per year, while dental x-rays are covered once per year for bitewing x-rays, and once every five years for full-mouth or panoramic x-rays; other diagnostic dental services and fluoride treatments are offered as optional, supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Spirit (HMO-POS) plan. Medicare Part B Insulin Drugs have a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Spirit (HMO-POS) plan. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance and Prosthetics/Medical Supplies with coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Equipment requires prior authorization and is limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Spirit (HMO-POS) plan. Diagnostic services and lab services are not covered, while diagnostic radiological services have a copay of $150.00.
Home Health Services See details
Home Health Services are covered under the Spirit (HMO-POS) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Spirit (HMO-POS) plan, but require prior authorization. There is no copay for days 1-6, a $20 copay for days 7-20, and no copay for days 21-100; the service-specific out-of-pocket maximum is $280.00.
Other Services See details
The Spirit (HMO-POS) plan's Other Services benefit includes coverage for Over-the-Counter (OTC) items, with a maximum benefit of $30 every three months, including nicotine replacement therapy and Naloxone. Acupuncture, Meal Benefit, 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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