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Network Health Zero (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Network Health Zero (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Network Health Zero (PPO) in 2026, please refer to our full plan details page.
Network Health Zero (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 Zero (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 Zero (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 Zero (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 $2.00. 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 $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 $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:
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Drug Coverage
The Network Health Zero (PPO) Medicare plan features an annual drug deductible of $330. For Tier 1 preferred generic drugs, you pay no copay for a one-month or three-month supply at preferred pharmacies and preferred mail-order services, while standard pharmacies charge an $8 copay for a one-month supply. Tier 2 generic drugs cost an $8 copay for a one-month supply at preferred pharmacies, and you can get a three-month supply with no copay through preferred mail order. For higher-tier medications, your costs transition from flat copays to coinsurance percentages. Tier 3 preferred brand drugs require 23% coinsurance at preferred pharmacies and 25% at standard pharmacies, while Tier 4 non-preferred drugs carry a flat 25% coinsurance across all pharmacy options. Tier 5 specialty drugs require 29% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Network Health Zero (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialist visits and urgent care, members will pay a $55 copay with no coinsurance. Inpatient hospital stays require a daily copay of $340 for the first seven days, while outpatient hospital services carry a $300 copay. This plan also features robust supplemental benefits, including no copay for eyewear and most dental services up to a $515 annual limit. Routine eye exams are available for a $10 copay, while routine hearing exams require a $55 copay. Additionally, diagnostic lab services, home infusions, and select over-the-counter items are covered with no copay.
Inpatient Hospital See details
Network Health Zero (PPO) covers inpatient hospital services with no coinsurance, requiring a $340 daily copay for days 1 through 7 of acute stays and a $395 daily copay for days 1 through 4 of psychiatric stays, with no copay for remaining days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Network Health Zero (PPO) covers outpatient hospital and observation services with a $300 copay and ambulatory surgical center services with a $250 copay, all with no coinsurance and requiring prior authorization. Outpatient substance abuse sessions require a $40 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Network Health Zero (PPO) plan with a $55.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Network Health Zero (PPO) covers ground and air ambulance services with a $300 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered with no copay and no coinsurance for unlimited round-trip taxi rides to any health-related location, while transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Network Health Zero (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $55 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $100,000 limit with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Network Health Zero (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical, occupational, and speech therapies require a $55 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services are covered with a $40 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Network Health Zero (PPO) covers preventive services, including annual physicals, kidney disease education, and select screenings, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, covering therapeutic massage, nutritional benefits, and memory fitness, but excluding health education, weight management, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Network Health Zero (PPO) covers annual routine hearing exams and fittings with a $55 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $495 to $1,695, but OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Network Health Zero (PPO), offering routine eye exams for a $10 copay and other eye exams for a $55 copay with no coinsurance, while other eye exam services are not covered. Eyewear, including contact lenses, eyeglasses, and upgrades, is fully covered with no copay and no coinsurance.
Dental Services See details
Network Health Zero (PPO) covers Medicare-covered dental services with a $55 copay and no coinsurance. Other preventive and comprehensive dental services—including exams, cleanings, and orthodontics—are covered with no copay and no coinsurance, up to a maximum annual benefit of $515 for combined in-network and out-of-network care.
Home Infusion bundled Services See details
Network Health Zero (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Network Health Zero (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Network Health Zero (PPO) covers medical equipment with prior authorization, offering durable medical equipment and medical supplies with no copay and 0% to 20% coinsurance, alongside prosthetic devices with no copay and 20% coinsurance. Diabetic equipment is partially covered, featuring diabetic therapeutic shoes and inserts for a $10 copay and no coinsurance, though diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Network Health Zero (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures require a $20 to $30 copay and no coinsurance, lab services have no copay, and radiological services carry a $30 copay for X-rays, a minimum $30 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Network Health Zero (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Network Health Zero (PPO) plan, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are all not covered in practice. While the plan offers no coinsurance, these individual services are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Network Health Zero (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and days 46 to 100, and a $218 daily copay for days 21 to 45. Prior authorization is required, and while a prior three-day hospital stay is not needed for admission, additional days beyond the Medicare-covered 100-day limit are not covered.
Other Services See details
Network Health Zero (PPO) covers other services including acupuncture, over-the-counter items, meal benefits for chronic illnesses, and lipid profile, fasting blood sugar, and CBC tests with no copay and no coinsurance.
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