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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 2025, 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 5 out of 5 stars in 2025.
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.
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 $145.00 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 Zero (PPO)
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Drug Coverage
The Network Health Zero (PPO) plan has a $145.00 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 $8.00 copay at a preferred pharmacy or preferred mail order, and a $15.00 copay at a standard pharmacy or standard mail order. For preferred brand drugs, you'll pay 41% coinsurance regardless of pharmacy. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Network Health Zero (PPO) plan offers comprehensive coverage with a variety of benefits. This plan provides coverage for inpatient hospital stays, outpatient services, and emergency care, with varying copays for different services. Primary care physician services have no copay, while other services like specialist visits have a copay of $55. Additional benefits include coverage for vision, hearing, and dental services. The plan also covers home health services, skilled nursing facilities, and medical equipment. There is no copay for home health services, but there are copays for hearing exams, and eye exams.
Inpatient Hospital See details
Inpatient Hospital-Acute has a copay of $340 for days 1-7, and no copay for days 8-90. Inpatient Hospital Psychiatric has a copay of $395 for days 1-4, and no copay for days 5-90. Additional Days for Inpatient Hospital-Acute is covered with no copay. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, 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 between $0 and $300, observation services with a $300 copay, and ambulatory surgical center services with no copay. Individual and group outpatient substance abuse sessions have a $40 copay, but outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Network Health Zero (PPO) plan. This benefit has a $55 copay and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $300 copay for both ground and air ambulance services; however, transportation services to a plan-approved health-related location are not covered. Transportation services to any health-related location are covered, including round trip taxi services.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Network Health Zero (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 copay; there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care, for the Network Health Zero (PPO) plan, includes coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $55 copay, Physician Specialist Services with a $55 copay, Mental Health Specialty Services with a $40 copay for individual and group sessions, Other Health Care Professional services with a $55 copay, Psychiatric Services with a $40 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $55 copay, Additional Telehealth Benefits with a copay between $0 and $55, and Opioid Treatment Program Services with a $40 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Network Health Zero (PPO) plan covers preventive services, including annual physical exams, with no copay or coinsurance. Additional preventive services are partially covered, as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. The plan also covers therapeutic massage, nutritional/dietary benefits, fitness benefits, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing services include hearing exams with a $55 copay, and coverage for fitting/evaluation for hearing aids and prescription hearing aids. Prescription hearing aids (all types) have a copay between $495 and $1695, and prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Vision services are covered, including eye exams with a $55 copay, routine eye exams with a $10 copay, and coverage for eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. The plan has a maximum benefit coverage amount of $40 for eye exams.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $55 copay, and other dental services, including 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. Orthodontic services are covered under Diagnostic and Preventive Dental (16b). The plan has a maximum benefit of $580 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B insulin drugs, there is a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Network Health Zero (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20% and Prosthetics/Medical Supplies with a coinsurance. Diabetic Therapeutic Shoes/Inserts have a $10 copay, while Diabetic Supplies are not covered, and Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Network Health Zero (PPO) plan. Diagnostic Procedures/Tests have a copay between $20 and $30, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $30 and $300, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by the Network Health Zero (PPO) plan 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 covered by the Network Health Zero (PPO) plan. However, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20 and days 46-100, there is no copay, and for days 21-45, the copay is $214.
Other Services See details
The Network Health Zero (PPO) plan covers acupuncture with no copay, over-the-counter (OTC) items, including nicotine replacement therapy and naloxone, and a meal benefit for chronic illnesses. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and many others are not covered.
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