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Network Health Cares (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Network Health Cares (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Network Health Cares (PPO D-SNP) in 2025, please refer to our full plan details page.
Network Health Cares (PPO D-SNP) is a PPO D-SNP plan offered by Network Health, Inc. available for enrollment in 2025 to people living in East Central Wisconsin. This plan received an overall rating of 5 out of 5 stars in 2025.
It's important to know that Network Health Cares (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Network Health Cares (PPO 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 Network Health Cares (PPO 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 Network Health Cares (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $43.50. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.50. 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 $590.00 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 combined Maximum Out-Of-Pocket cost of $12450.00 (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 $12450.00 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:
Sign up for Network Health Cares (PPO D-SNP)
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Drug Coverage
The Network Health Cares (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs. The plan's premium may be reduced if you qualify for the low-income subsidy (LIS). During the initial coverage phase, you will pay costs for drugs until your total drug costs reach $2000. Once you reach $2000 in out-of-pocket drug costs, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The Network Health Cares (PPO D-SNP) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with varying coinsurance costs. Emergency, primary care, and hearing services are covered, along with vision and dental services. You will also find coverage for home health services, dialysis services, and medical equipment. Additional benefits include transportation services, home infusion services, and coverage for over-the-counter items. However, some services like cardiac rehabilitation, additional home health care, and some preventive services are not covered. The plan's cost structure involves copays and coinsurance, so be sure to review the details to understand your out-of-pocket expenses.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Additional Days, Non-Medicare-covered Stays, and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stays for Inpatient Hospital Psychiatric, are not covered. For covered services, you will have a copay; however, the exact amount is not specified.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, are covered with a 20% coinsurance. Individual and group sessions for outpatient substance abuse are also covered, with a coinsurance between 20% and 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Network Health Cares (PPO D-SNP) plan. This benefit has a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance, and transportation services to plan-approved health-related locations with 36 one-way taxi trips per year. Transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Network Health Cares (PPO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, with a maximum per visit amount of $110 and $45, respectively. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation is not covered.
Primary Care See details
Under the Network Health Cares (PPO D-SNP) plan, primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered with a 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services are covered, but annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. In-home support services and fitness benefits are covered. Kidney disease education services, diabetes self-management training, and other preventive services have a 20% coinsurance, while glaucoma screenings, barium enemas, digital rectal exams, and EKGs following welcome visits are covered with no coinsurance.
Hearing Services See details
Hearing services, including hearing exams, are covered. Routine hearing exams and fitting/evaluation for hearing aids are covered once per year, with a 20% coinsurance for routine hearing exams. Prescription hearing aids are covered with a copay between $495 and $1695, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, with a maximum benefit of $40 every year, and eyewear has a 20% coinsurance, with a combined maximum benefit of $400 every year. Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a 20% coinsurance, other dental services, oral exams (2 visits per year), dental x-rays (1 per year), other diagnostic dental services, prophylaxis (cleaning) (2 visits per year), fluoride treatment (1 per year), other preventive dental services, and restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, and oral and maxillofacial surgery. Orthodontic Services and Implant Services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, 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 Network Health Cares (PPO D-SNP) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a 20% coinsurance and a $0 copay, Prosthetics/Medical Supplies with a 20% coinsurance and a $0 copay, and Diabetic Equipment with a 20% coinsurance and a $0 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, and lab services, with a coinsurance of at most 20% and no copay. Radiological services are also covered, including diagnostic and therapeutic radiological services, and outpatient X-ray services, with a coinsurance of at most 20% and no copay.
Home Health Services See details
Home Health Services are covered by Network Health Cares (PPO D-SNP) with no copay and no coinsurance, though authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Network Health Cares (PPO D-SNP) plan. Some services are covered, but 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) benefits are covered by Network Health Cares (PPO D-SNP), but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the copay information is available in the plan details.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $225.00 every three months, and a Meal Benefit, but does not cover Acupuncture, 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.
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