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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 2026, 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 4.5 out of 5 stars in 2026.
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 $3.20. 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 $330.00 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 features an annual drug deductible of $330. For Tier 1 preferred generics, you will pay as low as a $1.00 copay for a one-month supply at preferred pharmacies, with no copay required for a three-month supply filled through preferred mail order. Tier 2 generic prescriptions cost an $8.00 copay for a one-month supply at preferred pharmacies, and also feature no copay for a three-month supply via preferred mail order. For higher-tier medications, costs are based on coinsurance. Tier 3 preferred brand drugs carry a 21% coinsurance at preferred pharmacies and mail-order services, which rises to 25% at standard pharmacies. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 29% coinsurance regardless of whether you use preferred or standard pharmacy and mail-order options.
Additional Benefits
Network Health Select (PPO) provides comprehensive medical coverage featuring no copays for primary care visits, home health care, and routine preventive services. Inpatient hospital stays, specialist visits, and emergency care are covered with flat copayments and no coinsurance. Outpatient services and surgeries are also accessible with fixed copays and no coinsurance, keeping your healthcare costs highly predictable. Beyond standard medical care, this plan offers valuable extra benefits such as dental exams and cleanings with no copay up to a $460 annual limit, as well as eyewear with no copay. Members also benefit from unlimited health-related taxi transportation at no cost, while specialized services like hearing aids, diagnostic imaging, and durable medical equipment are covered with affordable copayments or coinsurance.
Inpatient Hospital See details
Network Health Select (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $275 daily copay for days 1 to 6 of acute stays and a $395 daily copay for days 1 to 4 of psychiatric stays, followed by no copay for subsequent days. Prior authorization is required, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under Network Health Select (PPO) are covered with no coinsurance, featuring a $300 copay for outpatient hospital and observation services and a $250 copay for ambulatory surgical center services, both of which require prior authorization. Outpatient substance abuse services require prior authorization and have a $40 copay per session with no coinsurance, while outpatient blood services are fully covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Network Health Select (PPO) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Network Health Select (PPO) covers ground and air ambulance services with a $300 copay and no coinsurance, subject to prior authorization. The plan also covers unlimited round-trip taxi transportation to any health-related location with no copay and no coinsurance, though prior authorization is required.
Emergency Services See details
Network Health Select (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $60 copay and no coinsurance. Worldwide emergency and urgent care are partially covered with a $130 copay and no coinsurance up to a maximum benefit of $100,000, though worldwide emergency transportation is not covered.
Primary Care See details
Network Health Select (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $60 copay and no coinsurance. Physical, occupational, and speech therapies require a $55 copay and no coinsurance, mental health services cost a $40 copay and no coinsurance, while podiatry and chiropractic services are not covered in practice.
Preventive Services See details
Network Health Select (PPO) preventive services are partially covered with no copay and no coinsurance, including annual physicals, kidney disease education, glaucoma screenings, diabetes training, unlimited therapeutic massage, and memory fitness. However, sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, adult day health, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Network Health Select (PPO) covers annual routine hearing exams and fittings with a $60 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $495 to $1,695, though over-the-counter options as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Network Health Select (PPO), featuring eye exams with no deductible, no coinsurance, and a $60 copay ($10 copay for one annual routine exam), though other eye exam services are not covered. Eyewear, including unlimited eyeglasses and contact lenses, is covered with no copay, no coinsurance, and no deductible.
Dental Services See details
Network Health Select (PPO) covers Medicare-covered dental services with a $60 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance. These additional dental services, which include exams, cleanings, and restorative care, are subject to a maximum annual benefit of $460 for both in-network and out-of-network care.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Network Health Select (PPO) with no copay, though prior authorization and step therapy are required. Covered Medicare Part B drugs, including chemotherapy and insulin, require coinsurance ranging from no coinsurance up to 20%, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered by Network Health Select (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Network Health Select (PPO) covers medical equipment, featuring durable medical equipment and medical supplies with no copay and 0% to 20% coinsurance, and prosthetic devices with no copay and 20% coinsurance. Diabetic equipment is partially covered, offering therapeutic shoes and inserts for a $10 copay and no coinsurance, though diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Network Health Select (PPO) and require prior authorization. Members pay no copay or coinsurance for lab services, a $20 to $40 copay with no coinsurance for diagnostic tests, a $40 copay for X-rays, a minimum $40 copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Network Health Select (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Network Health Select (PPO) with no coinsurance, although some services are not covered, including standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD), which require a $15 copay.
Skilled Nursing Facility (SNF) See details
Network Health Select (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 46 to 100, while days 21 to 45 require a $218 daily copay; additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are covered under Network Health Select (PPO) with no copay and no coinsurance, including unlimited acupuncture, over-the-counter items, chronic illness meal benefits, and lipid profile, fasting blood sugar, and CBC tests. Dual Eligible SNPs with highly integrated services are not covered under this plan.
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