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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 2026, 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 4.5 out of 5 stars in 2026.
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 $21.10. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.90. 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 combined Maximum Out-Of-Pocket cost of $13900.00 (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 $13900.00 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 Network Health Cares (PPO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This is the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. While specific drug tier copayments and coinsurance details are not currently available, knowing the deductible helps you estimate your initial healthcare spending. To get a complete picture of your potential costs, you should consult the plan's formulary for specific medication coverage.
Additional Benefits
The Network Health Cares (PPO D-SNP) plan offers comprehensive coverage where most medical services, including outpatient care, primary care, specialist visits, diagnostic tests, and medical equipment, feature no copay and a 20% coinsurance. Inpatient hospital stays are subject to Medicare-defined copayments with no coinsurance, while home health and skilled nursing facility services are covered with no copay and no coinsurance. Emergency and urgent care services also require no copay and a 20% coinsurance, with costs capped to limit your out-of-pocket expenses. This plan also provides valuable supplemental benefits, including preventive and comprehensive dental care up to a $3,000 annual maximum, as well as select preventive services, all with no copay and no coinsurance. Additionally, members can benefit from routine vision and hearing exams with no copay and a 20% coinsurance, up to 52 one-way taxi trips per year to approved locations with no copay or coinsurance, and a $280 allowance every three months for over-the-counter items. Prescription hearing aids are also covered with no coinsurance and a copay ranging from $495 to $1,695.
Inpatient Hospital See details
Network Health Cares (PPO D-SNP) partially covers inpatient acute and psychiatric hospital stays, which require prior authorization and are subject to Medicare-defined copayments with no coinsurance. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Network Health Cares (PPO D-SNP) covers outpatient services with no copay, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services. A 20% coinsurance applies to these covered services, and prior authorization is required for outpatient hospital, observation, ambulatory surgical, and substance abuse services.
Partial Hospitalization See details
Partial hospitalization is covered by Network Health Cares (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Network Health Cares (PPO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 52 one-way taxi trips per year to plan-approved locations with no copay or coinsurance, while trips to any other health-related locations are not covered.
Emergency Services See details
Network Health Cares (PPO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, capped at a maximum of $115 and $40 per visit. Worldwide emergency and urgent care are partially covered up to a $100,000 maximum with a $125 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Network Health Cares (PPO D-SNP) covers primary care, specialist, mental health, therapy, and opioid treatment services with no copay and 20% coinsurance, though prior authorization is generally required. Additional telehealth benefits are available with no copay and 0% to 20% coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under Network Health Cares (PPO D-SNP), featuring Medicare-covered zero-dollar preventive services alongside select additional benefits like memory fitness and in-home support with no copay and no coinsurance. Other covered services, such as kidney disease education and diabetes self-management training, require no copay and a 20% coinsurance, while an annual physical exam and health education are not covered.
Hearing Services See details
Hearing services are partially covered by Network Health Cares (PPO D-SNP), offering annual routine exams and fittings with no copay and a 20% coinsurance on routine exams. Prescription hearing aids have no coinsurance but require a $495 to $1,695 copay, while OTC hearing aids and inner ear, outer ear, or over the ear prescription hearing aids are not covered.
Vision Services See details
Network Health Cares (PPO D-SNP) partially covers vision services with no copays, requiring a 20% coinsurance for routine eye exams and contact lenses. Covered services include one routine exam per year (up to $40) and combined eyeglasses and contact lenses (up to $400), while other eye exam services, eyeglass lenses, and eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered by Network Health Cares (PPO D-SNP), offering Medicare-covered dental with no copay and a 20% coinsurance, alongside preventive and other comprehensive services with no copay and no coinsurance up to a $3,000 annual maximum. Orthodontics is not covered under this plan.
Home Infusion bundled Services See details
Network Health Cares (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Network Health Cares (PPO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Network Health Cares (PPO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Network Health Cares (PPO D-SNP) covers diagnostic and radiological services, including lab services, X-rays, and therapeutic radiological services, with no copay and a 20% coinsurance. Prior authorization is required for all of these covered diagnostic and radiological procedures.
Home Health Services See details
Home health services are covered under the Network Health Cares (PPO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Network Health Cares (PPO D-SNP) covers some cardiac rehabilitation services with no copay, but key services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Network Health Cares (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required. Stays do not require a prior three-day inpatient hospital stay, but additional days beyond standard Medicare coverage are not covered.
Other Services See details
Network Health Cares (PPO D-SNP) partially covers other services, featuring a meal benefit and up to $280 every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and dual eligible SNPs with highly integrated services are not covered.
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