A non-government entity
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 2026, 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 4.5 out of 5 stars in 2026.
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 $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 $7400.00 (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 $7400.00 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) prescription drug plan features an annual drug deductible of $340. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail order service. For Tier 2 generic drugs, copays start as low as $8 for a 1-month supply at preferred pharmacies, and there is no copay for a 3-month supply filled via preferred mail order. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require 23% coinsurance at preferred pharmacies and 25% coinsurance at standard pharmacies, while Tier 4 non-preferred drugs carry a flat 25% coinsurance across all network pharmacies. Tier 5 specialty drugs require a 29% coinsurance for a 1-month supply, regardless of the pharmacy or mail order service you choose.
Additional Benefits
The Network Health Go (PPO) plan offers comprehensive medical coverage featuring no copays for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a daily copay of $295 for days one through six of acute stays with no coinsurance. Specialist visits and physical therapy require a $50 copay, while emergency room services carry a $130 copay that is waived upon admission. Essential extras like routine dental care and unlimited eyewear frames and lenses are covered with no copay, though dental benefits are subject to a $1,000 annual limit. Members also benefit from unlimited health-related transportation and over-the-counter items at no copay. Hearing services include a $50 copay for routine exams and a copay between $495 and $1,695 for prescription hearing aids.
Inpatient Hospital See details
Network Health Go (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $295 daily copay for days 1 through 6 of acute stays and a $395 daily copay for days 1 through 4 of psychiatric stays. While there is no copay for subsequent stay days and unlimited additional acute days are covered, non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the Network Health Go (PPO) plan are covered with no coinsurance, featuring a $275 copay for outpatient hospital and observation services and a $225 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $50 copay, while outpatient blood services are covered with no copay.
Partial Hospitalization See details
Network Health Go (PPO) covers partial hospitalization services with a $50 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Network Health Go (PPO) covers ground and air ambulance services with a $275 copay and no coinsurance. Transportation services are partially covered, providing unlimited round-trip taxi rides to any health-related location with no copay and no coinsurance, while plan-approved health-related locations are not covered.
Emergency Services See details
Network Health Go (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 $50 copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $100,000 maximum benefit with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Network Health Go (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical or occupational therapy, and mental health services require a $50 copay and no coinsurance. Some chiropractic services are covered with a $15 copay and no coinsurance, but routine and other chiropractic services are not covered, and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Network Health Go (PPO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are only partially covered, excluding benefits such as health education, weight management programs, in-home support, and personal emergency response systems.
Hearing Services See details
Hearing services are covered by Network Health Go (PPO) with no deductible, offering annual routine exams and fitting evaluations for a $50 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay between $495 and $1,695, though inner ear, outer ear, over-the-ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Network Health Go (PPO) offers partially covered vision services, which include routine eye exams for a $10 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, which includes unlimited contact lenses, frames, lenses, and upgrades.
Dental Services See details
Network Health Go (PPO) covers Medicare-covered dental services with a $50 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance. These other services, including exams, cleanings, and implants, are subject to a combined in-network and out-of-network maximum benefit of $1,000 every year.
Home Infusion bundled Services See details
Network Health Go (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Network Health Go (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Network Health Go (PPO) partially covers medical equipment, with diabetic supplies excluded from coverage. Covered durable medical equipment, prosthetics, and medical supplies feature no copay and up to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Network Health Go (PPO) with prior authorization, featuring no coinsurance for diagnostic services, no copay for lab services, and a $20.00 to $35.00 copay for diagnostic tests. Radiological services require a $35.00 copay plus coinsurance for outpatient X-rays, a minimum $35.00 copay for diagnostic radiological services, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered by Network Health Go (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Network Health Go (PPO) with no coinsurance, and while some services are covered, specific programs including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require a $25 copay.
Skilled Nursing Facility (SNF) See details
Network Health Go (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and days 46 through 100, but requiring a $218 copay for days 21 through 45. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Network Health Go (PPO) covers other services including acupuncture, over-the-counter items, meal benefits for chronic illness, and select lab tests with no copay and no coinsurance. While these primary benefits are covered, some miscellaneous services under this category are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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