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Network Health Bravo (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Network Health Bravo (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Network Health Bravo (PPO) in 2025, please refer to our full plan details page.
Network Health Bravo (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 Bravo (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 Bravo (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 Bravo (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 $8000.00 (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 $8000.00 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 Bravo (PPO).
Additional Benefits
The Network Health Bravo (PPO) plan offers a range of benefits with varying cost-sharing. For inpatient hospital stays, you'll pay a copay, with no copay after a certain number of days. Outpatient services have copays, while emergency and urgent care services have copays as well. The plan also covers primary care and specialist visits with copays, along with mental health services and therapy. Additional benefits include hearing and vision coverage, with copays for exams and allowances for eyewear and hearing aids, as well as dental services with a maximum annual benefit. Other covered services include home health, diagnostic and radiological services, and skilled nursing facility stays with varying copays.
Inpatient Hospital See details
Inpatient Hospital services are covered under the Network Health Bravo (PPO) plan, with a copay of $295 for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute, and a copay of $395 for days 1-4 and no copay for days 5-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Network Health Bravo (PPO) plan, including all outpatient hospital services with a copay between $0 and $275, and observation services with a $275 copay. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services cover individual and group sessions, both with a copay of $20. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Network Health Bravo (PPO) plan with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under Network Health Bravo (PPO). Ground and Air Ambulance Services have a $300 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 by Network Health Bravo (PPO). Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $45 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care services are covered. Chiropractic Services require prior authorization and have a $20 copay. Occupational Therapy Services require prior authorization and have a $30 copay. Physician Specialist Services require prior authorization and have a $40 copay. Mental Health Specialty Services, including individual and group sessions, require prior authorization and have a $20 copay. Podiatry Services are not covered. Other Health Care Professional services require prior authorization and have a $40 copay. Psychiatric Services, including individual and group sessions, require prior authorization and have a $20 copay. Physical Therapy and Speech-Language Pathology Services require authorization and have a $30 copay. Additional Telehealth benefits are covered with a copay between $0 and $40, and Opioid Treatment Program Services require prior authorization with a $20 copay.
Preventive Services See details
The Network Health Bravo (PPO) plan covers preventive services, including Medicare-covered services, annual physical exams, kidney disease education services, and other preventive services. Fitness benefits and the following additional preventive services are not covered: 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.
Hearing Services See details
Hearing exams are covered with a $40 copay, and you can get one routine hearing exam and one fitting/evaluation for a hearing aid per year. Prescription hearing aids are covered with a copay between $495 and $1695, while inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a $40 copay, eyewear with a combined maximum of $400 every year, and contact lenses. Eyeglass lenses and frames are not covered.
Dental Services See details
The Network Health Bravo (PPO) plan covers Medicare dental services with a $40 copay. 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. The plan has a maximum benefit of $5,000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs also have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Network Health Bravo (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by Network Health Bravo (PPO), with Durable Medical Equipment (DME) and Prosthetics/Medical Supplies covered, along with Diabetic Equipment, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. For DME, there is a coinsurance of 0-20%, while Diabetic Therapeutic Shoes/Inserts have a copay of $10.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures and tests, are covered under the plan, with a copay of $20.00 and lab services with no copay. Radiological services are also covered, including diagnostic radiological services with a copay up to $200.00, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $35.00 copay.
Home Health Services See details
Home Health Services are covered by the Network Health Bravo (PPO) plan with no copay and no coinsurance, however, 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 generally covered, but not in practice because the plan does not cover any of the sub-services. There is a copay for the services that are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay; for days 21-45, the copay is $214; and for days 46-100, there is no copay.
Other Services See details
Other Services for Network Health Bravo (PPO) covers Over-the-Counter (OTC) Items up to $100 every three months, including nicotine replacement therapy and naloxone. Acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered.
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