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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 2025, 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 5 out of 5 stars in 2025.
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.
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.
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:
Sign up for Network Health Armor (PPO)
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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 a range of benefits, including inpatient hospital stays with copays, outpatient services with varying copays, and partial hospitalization with a $40 copay. Emergency and urgent care services are covered, as are primary care visits with copays ranging from $20 to $40. Hearing, vision, and dental services are included, with copays for exams and services, as well as coverage for hearing aids, eyewear, and a $5,000 annual dental benefit. Additional benefits include ambulance services with a $300 copay, home health services with no copay, and skilled nursing facility stays with copays depending on the length of stay. Diagnostic and radiological services are covered with copays and coinsurance. The plan also covers medical equipment, home infusion, and dialysis services with coinsurance.
Inpatient Hospital See details
Inpatient Hospital services, including those not usually covered by Medicare, are covered. For Inpatient Hospital-Acute, you have a \$295 copay for days 1-6, and no copay for days 7-90. Inpatient Hospital Psychiatric has a \$395 copay for days 1-4, and no copay for days 5-90. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric and Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $275, Observation Services with a $275 copay, Ambulatory Surgical Center (ASC) Services with no copay, and both Individual and Group Sessions for Outpatient Substance Abuse with a $20 copay. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial hospitalization is covered under this plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Network Health Armor (PPO) plan. Ground and air ambulance services have a $300 copay, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Network Health Armor (PPO) plan with a $125 copay, and no coinsurance. Urgently Needed Services have a $40 copay and no coinsurance. Worldwide Emergency Services are covered, with a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Network Health Armor (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a $40 copay, mental health specialty services with a $20 copay, other health care professional services with a $40 copay, psychiatric services with a $20 copay, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $20 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, annual physical exams, additional preventive services, kidney disease education services, and other preventive services. 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, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, 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.
Hearing Services See details
Hearing Services include routine hearing exams with a $40 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $495 and $1695, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $40 copay, and eyewear with a combined maximum benefit of $400 per year. Contact lenses and eyeglasses (lenses and frames) are also covered. Eyeglass lenses and frames are not covered.
Dental Services See details
The Network Health Armor (PPO) plan covers dental services with a $40 copay for Medicare Dental Services. Other Dental Services include oral exams (2 per year), dental x-rays (1 per year), other diagnostic dental services, prophylaxis (cleaning) (2 per year), fluoride treatment (1 per year), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, maxillofacial prosthetics, implant services (1 per year), prosthodontics, fixed, and oral and maxillofacial surgery. Orthodontics is not covered. There is a maximum plan benefit coverage of $5,000 per year, applicable to both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Network Health Armor (PPO) plan. For Medicare Part B insulin drugs, there is a $35 copay and 0-20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Network Health Armor (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, with Durable Medical Equipment subject to a 0-20% coinsurance and Prosthetic Devices subject to a 20% coinsurance. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $20 and $40, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $40 and $125, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by the Network Health Armor (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Network Health Armor (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. There is no copay for days 1-20, a $214 copay for days 21-45, and no copay for days 46-100.
Other Services See details
The Network Health Armor (PPO) plan does not cover acupuncture, 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, or Self-Directed Personal Assistance Services. Over-the-counter (OTC) items and "Other 1" services are covered; OTC items have a maximum benefit of $100 every three months, including nicotine replacement therapy and Naloxone.
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