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Network Health Armor (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Network Health Armor (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Network Health Armor (PPO) in 2026, please refer to our full plan details page.
Network Health Armor (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 Armor (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Network Health Armor (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 Armor (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 $25.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $4900.00 (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 $4900.00 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
Prescription drugs are not covered by Network Health Armor (PPO).
Additional Benefits
The Network Health Armor (PPO) plan offers robust coverage for essential medical services, often featuring no coinsurance and predictable copays. Members enjoy no copay for primary care visits, home health services, and annual preventive physical exams. Specialist visits, urgent care, and routine eye or hearing exams require a $40 copay, while inpatient hospital stays carry a daily copay of $295 for the first six days of an acute stay. Additional benefits include a generous $5,000 annual limit for dental care with no copay for preventive and comprehensive services. The plan also provides up to $400 yearly for eyewear with no copay, a $100 quarterly over-the-counter allowance, and prescription hearing aid coverage with copays ranging from $495 to $1,695. Diagnostic lab work and home infusion services are also fully covered with no copay.
Inpatient Hospital See details
Network Health Armor (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $295 copay for days 1 through 6 of an acute stay and a $395 copay for days 1 through 4 of a psychiatric stay, with no copay for subsequent days. While unlimited additional acute days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Network Health Armor (PPO) covers outpatient services with no coinsurance, featuring a $275 copay per stay for outpatient hospital and observation services, and a $225 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $20 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Network Health Armor (PPO) covers partial hospitalization services with a $40 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Network Health Armor (PPO), with ground and air ambulance services requiring prior authorization, a $300 copay, and no coinsurance. While transportation services are technically covered, trips to plan-approved or any health-related locations are not covered in practice.
Emergency Services See details
Network Health Armor (PPO) covers emergency services with a $130 copay and no coinsurance (waived if admitted within 24 hours), and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $100,000 lifetime maximum with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Network Health Armor (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Other covered benefits, including physical therapy, mental health, and telehealth, feature copays ranging from $0 to $40 with no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Network Health Armor (PPO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered; a memory fitness benefit is included, but health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Network Health Armor (PPO), offering annual routine exams and fitting evaluations for a $40 copay and no coinsurance. Prescription hearing aids are covered with a copay ranging from $495 to $1,695 and no coinsurance, but OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
Network Health Armor (PPO) partially covers vision services, offering one routine eye exam per year for a $40 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $400 annual limit for contact lenses and complete eyeglasses, though separate eyeglass lenses and frames are not covered.
Dental Services See details
Network Health Armor (PPO) offers partially covered dental services with an annual maximum benefit of $5,000 for both in- and out-of-network care, excluding orthodontics which are not covered. Medicare-covered dental services require a $40 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance.
Home Infusion bundled Services See details
Network Health Armor (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs require a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin is covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Network Health Armor (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Network Health Armor (PPO) partially covers medical equipment, with no copay and 0% to 20% coinsurance for durable medical equipment (DME) and medical supplies, and a 20% coinsurance with no copay for prosthetics. Diabetic therapeutic shoes and inserts are covered with a $10 copay and no coinsurance, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Network Health Armor (PPO) with prior authorization required for all services. Diagnostic tests carry no coinsurance and a $20 to $40 copay, lab services have no copay or coinsurance, and radiological services require a $30 copay for X-rays, a minimum $40 copay for diagnostic radiology, and a 20% minimum coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Network Health Armor (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Network Health Armor (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered under the plan and carry a $15 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Network Health Armor (PPO) with no coinsurance, featuring no copay for days 1-20 and 46-100, and a $218 daily copay for days 21-45. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Network Health Armor (PPO) partially covers other services, offering over-the-counter (OTC) items up to $100 every three months and lipid, fasting blood sugar, and CBC tests with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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