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Compass (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Compass (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Compass (HMO-POS) in 2025, please refer to our full plan details page.
Compass (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 Compass (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 Compass (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 Compass (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 $3400.00 (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 $3400.00 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 Compass (HMO-POS).
Additional Benefits
The Compass (HMO-POS) plan offers a range of health benefits, including coverage for inpatient hospital stays with a $300 copay for the first five days, and no copay for days 6-90, as well as outpatient services with varying copays. The plan also covers emergency services with a $125 copay, and primary care services, such as chiropractic and occupational therapy, with copays ranging from $20-$50. Additional benefits include coverage for preventive services, hearing exams with a $50 copay, and vision services, including eye exams with a $50 copay. The plan covers dental services with specific limitations, home infusion services, dialysis services with 20% coinsurance, and medical equipment with a coinsurance between 0-20%. Other benefits include ambulance services with a $225 copay and skilled nursing facility services with no copay for certain days.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care with a $300 copay for days 1-5 and no copay for days 6-90; additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays and upgrades are not covered. Inpatient Hospital Psychiatric does not cover additional days or non-Medicare-covered stays.
Outpatient Services See details
Outpatient Services are covered under the Compass (HMO-POS) plan, with varying copays depending on the service. Outpatient Hospital Services and Observation Services have a copay between $0 and $200, Ambulatory Surgical Center (ASC) Services have no copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a copay of $50.
Partial Hospitalization See details
Partial Hospitalization is covered by the Compass (HMO-POS) plan.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Compass (HMO-POS) plan. Ground and Air Ambulance Services have a $225 copay and no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency services are covered, with a $125 copay. Urgently needed services are covered, with a copay between $0 and $50. Worldwide emergency services are also covered, with copays of $125 for Worldwide Emergency Coverage, between $0 and $50 for Worldwide Urgent Coverage, and $225 for Worldwide Emergency Transportation.
Primary Care See details
The Compass (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 $50 copay, mental health and psychiatric services with a $40 copay, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a $0-$225 copay, and opioid treatment program services with a $0-$50 copay and 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
The Compass (HMO-POS) plan covers preventive services including Medicare-covered services, annual physical exams, health education, in-home safety assessments, Kidney Disease Education Services, and other preventive services. Additional preventive services require prior authorization, and Home and Bathroom Safety Devices and Modifications have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a $50 copay, and routine hearing exams and fitting/evaluation for hearing aids are included. Prescription hearing aids (all types) are covered with a $500 copay, while prescription hearing aids for inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $50 copay, routine eye exams with a copay between $0 and $50, and other eye exam services with a copay between $0 and $50. Eyewear is covered, with a combined maximum of $175 per year for eyeglasses. Contact lenses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Compass (HMO-POS) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatment. Oral exams and cleanings are covered once per year, with x-rays covered once per year for bitewing x-rays, and once every five years for full-mouth or panoramic x-rays. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. 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 Compass (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a coinsurance of 0-20%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a coinsurance of 0-20%. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a $5 copay, while Lab Services are not covered. Diagnostic Radiological Services have a copay of $200, and Outpatient X-Ray Services have a $5 copay. Therapeutic Radiological Services are not covered.
Home Health Services See details
Home Health Services are covered by the Compass (HMO-POS) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Compass (HMO-POS) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Compass (HMO-POS) plan, but require prior authorization. There is no copay for days 1-6 and days 46-100, but there is a $20 copay for days 7-45, and the service-specific out-of-pocket maximum is $780.00.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items, with a maximum benefit of $30 every three months, and other services including Acupuncture, Meal Benefit, 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. Other 1 benefits are covered with prior authorization.
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