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Network Health Anywhere (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Network Health Anywhere (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Network Health Anywhere (PPO) in 2026, please refer to our full plan details page.
Network Health Anywhere (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 Anywhere (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 Anywhere (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 Anywhere (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 $21.00. 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 $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 $4500.00 (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 $4500.00 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 Anywhere (PPO) Medicare plan features a $320 annual drug deductible. For Tier 1 preferred generic drugs, you will pay a low $1 copay for a 1-month supply at a preferred pharmacy, or no copay for a 3-month supply through preferred mail order. Tier 2 generic prescription drugs cost as little as an $8 copay for a 1-month supply at preferred pharmacies, with no copay for a 3-month supply via preferred mail order. Brand-name and specialty medications are covered under coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance at preferred pharmacies and 25% at standard pharmacies, while Tier 4 non-preferred drugs carry a flat 28% coinsurance. Specialty Tier 5 prescriptions have a 29% coinsurance across all pharmacy and mail-order options for a 1-month supply.
Additional Benefits
The Network Health Anywhere (PPO) plan offers comprehensive medical coverage, featuring no copay and no coinsurance for primary care provider visits and home health services. Specialist visits, urgent care, and routine hearing and vision exams generally require a $45 copay with no coinsurance. For inpatient hospital stays, members pay a $275 daily copay for the first six days of acute care, with no copay or coinsurance required for subsequent days. This plan also includes valuable supplemental benefits, such as preventive dental care with no copay and comprehensive dental covered up to a $2,000 annual limit with a 50% coinsurance. Prescription eyewear is covered up to $350 annually with no copay, and members receive a $25 allowance every three months with no copay for over-the-counter items. Durable medical equipment and dialysis services are also covered with no copay and coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Network Health Anywhere (PPO) covers inpatient hospital services with no coinsurance, requiring a $275 daily copay for days 1 through 6 of acute stays and a $295 daily copay for days 1 through 4 of psychiatric stays. There is no copay for subsequent days of acute or psychiatric stays, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Prior authorization is required for these services.
Outpatient Services See details
Outpatient services are covered by Network Health Anywhere (PPO) with no coinsurance, featuring outpatient hospital copays ranging from $0 to $260 and ambulatory surgical center copays of $185. Outpatient substance abuse sessions require a $45 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Network Health Anywhere (PPO) covers partial hospitalization services with a $45.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Network Health Anywhere (PPO) covers Medicare-covered ground and air ambulance services with a $250 copay and no coinsurance, which require prior authorization. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Network Health Anywhere (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 $45 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $100,000 maximum with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Network Health Anywhere (PPO) covers primary care physician services with no copay and no coinsurance, and telehealth services with a $0 to $45 copay and no coinsurance. Specialist visits, mental health, psychiatric, opioid treatment, and physical, occupational, and speech therapies are covered with a $45 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Network Health Anywhere (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training. Many additional preventive services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and counseling, although a memory fitness benefit is included.
Hearing Services See details
Network Health Anywhere (PPO) covers annual routine hearing exams and fittings with a $45 copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with copays ranging from $495 to $1,695 and no coinsurance, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Network Health Anywhere (PPO) with no deductible, offering one routine eye exam per year with a $45 copay and no coinsurance, and eyewear with no copay and no coinsurance up to a $350 annual limit. Other eye exam services, individual eyeglass lenses, and individual eyeglass frames are not covered.
Dental Services See details
Network Health Anywhere (PPO) partially covers dental services up to a $2,000 annual limit, with orthodontic services not covered. Medicare-covered dental has a $45 copay and no coinsurance, preventive services have no copay and no coinsurance, and comprehensive services are covered with no copay and 50% coinsurance.
Home Infusion bundled Services See details
Network Health Anywhere (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Network Health Anywhere (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Network Health Anywhere (PPO) covers durable medical equipment and medical supplies with no copays and 0% to 20% coinsurance, while prosthetic devices require a 20% coinsurance and no copay. Diabetic equipment is partially covered, as diabetic supplies are not covered, though diabetic therapeutic shoes and inserts are covered with a $10 copay and no coinsurance. Prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Network Health Anywhere (PPO) covers diagnostic and radiological services with prior authorization, featuring no copay or coinsurance for lab services and a $40 to $90 copay with no coinsurance for diagnostic procedures. Outpatient X-rays and diagnostic radiological services require a $90 copay (minimum for radiology), while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Network Health Anywhere (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Network Health Anywhere (PPO) with no coinsurance, meaning some services are covered, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Network Health Anywhere (PPO) with no coinsurance, featuring no copay for days 1 to 20 and 46 to 100, and a $218 daily copay for days 21 to 45. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Network Health Anywhere (PPO), featuring over-the-counter (OTC) items and select lab tests with no copay and no coinsurance. Acupuncture and meal benefits are not covered, and the OTC benefit has a maximum coverage limit of $25 every three months.
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