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Network Health Select (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Network Health Select (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Network Health Select (PPO) in 2025, please refer to our full plan details page.
Network Health Select (PPO) is a PPO 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 Select (PPO) 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 Network Health Select (PPO).
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 Select (PPO), 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. Additionally, this plan comes with a Part B Premium reduction of $2.00. 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 $340.00 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 $3900.00 (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 $3900.00 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 Select (PPO)
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Drug Coverage
The Network Health Select (PPO) plan has a $340 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, the copay is $8 at preferred pharmacies and mail order, and $15 at standard pharmacies. For standard generic drugs, you pay 24% coinsurance at preferred pharmacies and mail order, and 25% at standard pharmacies. Brand name drugs have a 50% coinsurance, and non-preferred drugs have 29% coinsurance. After your total drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Network Health Select (PPO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, with the cost varying depending on the type of service and length of stay. Outpatient services, emergency services, primary care, vision, and dental services all have copays. This plan also covers a wide range of services without a copay, including ambulance services, preventive services, home health services, and some diagnostic and radiological services. Additionally, it provides coverage for hearing services, medical equipment, home infusion, and skilled nursing facilities, with copays or coinsurance applying in certain cases.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $275 copay for days 1-6, and no copay for days 7-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you pay a $395 copay for days 1-4, and no copay for days 5-90; additional days are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a copay between $0 and $300, Observation Services with a $300 copay, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Network Health Select (PPO) plan, but requires prior authorization. The copay for this benefit is $60.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $300 copay for both ground and air ambulance services. Transportation Services to any health-related location are covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered by the Network Health Select (PPO) plan. Emergency Services has a $125 copay, and Urgently Needed Services has a $60 copay; both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $125 copay, and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Network Health Select (PPO) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services have a $20 copay, Physician Specialist Services have a $60 copay, and Physical Therapy and Speech-Language Pathology Services have a $55 copay; Individual and Group Sessions for Mental Health and Psychiatric services have a $40 copay, with Other Health Care Professional services having a minimum and maximum copay of $60. Additional Telehealth Benefits have a copay between $0 and $60. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Network Health Select (PPO) plan covers preventive services, including annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Therapeutic massage, nutritional/dietary benefits, and fitness benefits are also covered. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams with a $60 copay. Prescription hearing aids (all types) are covered with a copay between $495 and $1695, but prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $60 copay, as well as routine eye exams with a $10 copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $60 copay. This plan also covers Other Dental Services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics. There is a maximum plan benefit coverage of $550 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Network Health Select (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance between 0% and 20%. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $20 and $40, Lab Services have no copay, Diagnostic Radiological Services have a copay between $40 and $300, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the Network Health Select (PPO) plan with no copay or 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 not covered by the Network Health Select (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay; for days 21-45, the copay is $214; and for days 46-100, there is no copay.
Other Services See details
The Network Health Select (PPO) plan covers acupuncture, over-the-counter (OTC) items, meal benefits, and other services, with no copay or coinsurance. However, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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