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Network Health Go (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Network Health Go (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Network Health Go (PPO) in 2025, please refer to our full plan details page.
Network Health Go (PPO) is a PPO plan offered by Network Health, Inc. available for enrollment in 2025 to people living in Southeast Wisconsin. This plan received an overall rating of 5 out of 5 stars in 2025.
It's important to know that Network Health Go (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 Go (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 Go (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.
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 a $320.00 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 $6200.00 (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 $6200.00 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 Go (PPO)
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Drug Coverage
The Network Health Go (PPO) plan has a $320 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you'll pay an $8 copay at a preferred pharmacy or preferred mail order, or a $15 copay at a standard pharmacy or standard mail order. For standard generic drugs, you'll pay 24% coinsurance at a preferred pharmacy or preferred mail order, or 25% coinsurance at a standard pharmacy or standard mail order. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Network Health Go (PPO) plan offers comprehensive coverage for various healthcare needs. This plan includes coverage for inpatient and outpatient hospital services, with copays ranging from $0 to $395. Additional benefits include coverage for ambulance services, emergency care, primary care, preventive services, and services for hearing, vision, and dental. The plan also includes coverage for home health, skilled nursing facilities, and other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $295 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you pay a $395 copay for days 1-4, and no copay for days 5-90. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $275, and observation services with a $275 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $50 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 Go (PPO) plan. This benefit has a $50 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance services, are covered by the Network Health Go (PPO) plan. Ground and air ambulance services each have a copay of $275. Transportation Services to any health-related location are covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Network Health Go (PPO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $50 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Network Health Go (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $50 copay, physician specialist services with a $50 copay, mental health specialty services with a $50 copay, physical therapy and speech-language pathology services with a $50 copay, additional telehealth benefits with a $0-$50 copay, and opioid treatment program services with a $50 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Network Health Go (PPO) plan covers a variety of preventive services, including annual physical exams, kidney disease education, and other preventive services like glaucoma screenings and diabetes self-management training. This plan also covers therapeutic massage and a fitness benefit. However, health education, in-home safety assessments, and several other services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $50 copay, and routine hearing exams and fitting/evaluation for hearing aids are also covered. Prescription hearing aids (all types) are covered with a copay between $495 and $1695, however, 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
The Network Health Go (PPO) plan covers vision services, including eye exams with a $50 copay, and routine eye exams with a $10 copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay.
Dental Services See details
Dental Services are covered by the Network Health Go (PPO) plan, including Medicare Dental Services with a $50 copay, and other dental services with a maximum plan benefit of $1,200 per year. 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 are all covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay with 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Network Health Go (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with 0-20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Diabetic Therapeutic Shoes/Inserts have a $10 copay, and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services with a copay between $20 and $35, lab services with no copay, and radiological services. Diagnostic Radiological Services have a copay between $35 and $275, while Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the Network Health Go (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services. There is a copay for some services, but the details are not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Network Health Go (PPO) plan, but require prior authorization. You will have no copay for days 1-20, a $214 copay for days 21-45, and no copay for days 46-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Network Health Go (PPO) plan covers acupuncture with no copay, over-the-counter (OTC) items with no maximum coverage amount, and a meal benefit for a chronic illness with no maximum coverage amount. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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