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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 2025, 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 5 out of 5 stars in 2025.
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 $26.00. 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 $300.00 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 $3800.00 (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 $3800.00 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) plan has a $300 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 example, in the initial coverage phase, you will pay $8.00 for preferred generic drugs at a preferred pharmacy. The plan offers an enhanced alternative drug benefit.
Additional Benefits
The Network Health Anywhere (PPO) plan offers a variety of benefits, including inpatient hospital care with copays ranging from $0-$295, outpatient services with copays between $0 and $260, and primary care services with copays from $20-$35. This plan also covers emergency services with a $125 copay and preventive services, as well as hearing exams with a $35 copay and vision services with a $35 copay for eye exams. Additional benefits include dental services with a $35 copay for Medicare dental services and 50% coinsurance for other services, and home infusion bundled services with copays and coinsurance depending on the service. The plan also covers ambulance services with a $250 copay, and skilled nursing facility (SNF) services with no copay for some days, but a $214 copay for others. However, services such as cardiac rehabilitation, additional home health services, and many "other services" are not covered.
Inpatient Hospital See details
Inpatient hospital services are covered, including acute and psychiatric care. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $295 copay for days 1-4, and no copay for days 5-90. Additional days and upgrades for inpatient hospital, and non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services are covered by the Network Health Anywhere (PPO) plan, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient hospital services have a copay between $0 and $260, observation services have a $260 copay, and ambulatory surgical center services have no copay, while outpatient substance abuse services have a $35 copay for individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Network Health Anywhere (PPO) plan, with a $35 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Network Health Anywhere (PPO) plan. Ground and Air Ambulance Services have a $250 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Network Health Anywhere (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $35 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Network Health Anywhere (PPO) plan covers primary care services, including primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, while individual and group sessions for mental health and psychiatric services have a $35 copay. Occupational therapy services, physical therapy, and speech-language pathology services each have a $35 copay. Additional telehealth benefits have a copay between $0 and $35.
Preventive Services See details
The Network Health Anywhere (PPO) plan covers preventive services, including Medicare-covered services, annual physical exams, kidney disease education, and other preventive services. The plan also includes fitness benefits in the form of memory fitness. However, some services, such as health education, in-home safety assessments, and counseling services are not covered.
Hearing Services See details
Network Health Anywhere (PPO) covers hearing exams with a $35 copay, as well as fitting/evaluation for hearing aids with no coinsurance. Prescription hearing aids (all types) are covered with a copay between $495 and $1695. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a $35 copay, eyewear, contact lenses, and eyeglasses (lenses and frames), with a combined maximum benefit of $350 per year for eyewear. Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
The Network Health Anywhere (PPO) plan covers dental services, including Medicare Dental Services with a $35 copay. Other dental services include oral exams (2 per year), dental x-rays (1 per year), and prophylaxis (cleaning) (2 per year). Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics, fixed, and oral and maxillofacial surgery are covered with 50% coinsurance. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and other Medicare Part B drugs, chemotherapy, and radiation drugs, all with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Network Health Anywhere (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 0% to 20% coinsurance and Prosthetic Devices with 20% coinsurance, and Medical Supplies with 0% to 20% coinsurance. Diabetic Therapeutic Shoes/Inserts have a $10 copay, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $40 and $90, and outpatient lab services with no copay. Radiological services include coverage for diagnostic radiological services with a copay between $90 and $310, therapeutic radiological services with at least 20% coinsurance, and outpatient X-ray services with a $90 copay.
Home Health Services See details
Home Health Services are covered with no copay and no 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 Anywhere (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization, and have no copay for days 1-20 and days 46-100, but have a $214 copay for days 21-45. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered by the Network Health Anywhere (PPO) plan, including acupuncture, over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. Some Other Services, such as lipid profile, fasting blood sugar and CBC, are covered.
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