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Legacy Rx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Legacy Rx (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Legacy Rx (HMO-POS) in 2025, please refer to our full plan details page.
Legacy Rx (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 Legacy Rx (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Legacy Rx (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 Legacy Rx (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $247.40. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $2000.00 (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 $2000.00 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
The Legacy Rx (HMO-POS) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you'll pay a copay depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $20 copay at standard pharmacies, while specialty tier drugs have no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Legacy Rx (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $250 copay per stay, while outpatient services have copays between $0 and $100. Emergency services have a $125 copay, and primary care services have copays between $20 and $25. Preventive services have no copay, and hearing exams have a $25 copay. Vision services include eye exams with a $25 copay, and eyewear is covered up to $175 annually. Dental services cover oral exams, cleanings, and x-rays, and home health services have no copay.
Inpatient Hospital See details
The Legacy Rx (HMO-POS) plan covers Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, each with a $250 copay per stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and psychiatric services are not covered.
Outpatient Services See details
Outpatient Services, offered by Legacy Rx (HMO-POS), 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 benefits are covered by the Legacy Rx (HMO-POS) plan. There is no additional cost information provided for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Legacy Rx (HMO-POS) plan. Both ground and air ambulance services have a $175 copay, and there is 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 Legacy Rx (HMO-POS) plan. Emergency Services has a $125 copay, while Urgently Needed Services has a $0-$25 copay, and Worldwide Emergency Services has varying copays depending on the service. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $0-$25 copay, and Worldwide Emergency Transportation has a $175 copay.
Primary Care See details
The Legacy Rx (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 and psychiatric services with a $25 copay. Additionally, physical therapy and speech-language pathology services have a $20 copay, while additional telehealth benefits have a copay between $0-$175, and Opioid Treatment Program Services have a coinsurance of 20% and a copay between $0-$25. Podiatry services are not covered.
Preventive Services See details
The Legacy Rx (HMO-POS) plan covers preventive services, including Medicare-covered services with no copay, and additional preventive services that may require prior authorization. The plan also covers home and bathroom safety devices with a 20% coinsurance. Other services like counseling, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with a $25 copay. Prescription hearing aids are partially covered, and prescription hearing aids (all types) have a $500 copay, while prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a $25 copay, while routine eye exams and other eye exam services have a copay between $0 and $25. Eyewear is covered up to a combined maximum of $175 every year, and eyeglasses (lenses and frames) are covered. 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 treatments. Oral exams and cleanings are covered once per year, and dental x-rays are covered once per year, or a full-mouth x-ray once every five years, while other diagnostic dental services and fluoride treatments are optional supplemental benefits; all other dental services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while 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 by the Legacy Rx (HMO-POS) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 0% to 20% coinsurance; however, 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 partially covered under the Legacy Rx (HMO-POS) plan, with Diagnostic Procedures/Tests, Lab Services, Therapeutic Radiological Services, and Outpatient X-Ray Services not covered. Diagnostic Radiological Services have a copay of at most $150.00.
Home Health Services See details
Home Health Services are covered by the Legacy Rx (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan 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 Legacy Rx (HMO-POS) plan, with a $0 copay for days 1-6, a $20 copay for days 7-20, and a $0 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Legacy Rx (HMO-POS) plan covers over-the-counter items with a maximum benefit coverage of $30 every three months, including nicotine replacement therapy and Naloxone. Acupuncture, meal benefits, and several other services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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