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Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) in 2026, please refer to our full plan details page.
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) is a HMO plan offered by University of Wisconsin Hospitals and Clincs Autho available for enrollment in 2026 to people living in Western Wisconsin and Northeast Iowa. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) 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 Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO).
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 Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $196.00. 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 $200.00 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 Maximum Out-Of-Pocket cost of $3500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) prescription drug plan features a $200 annual drug deductible. Under this plan, Tier 6 select care drugs have no copay for one-, two-, or three-month fills at standard pharmacies or through standard mail order. Standard pharmacy and mail-order copays for Tier 1 preferred generics range from $2.00 to $5.00, while Tier 2 generics range from $10.00 to $25.00 depending on the supply duration. For brand-name and specialty medications, costs are structured as coinsurance at standard pharmacies and mail-order services. Tier 3 preferred brands require a 20% coinsurance, and Tier 4 non-preferred drugs carry a 40% coinsurance. Tier 5 specialty drugs are restricted to a one-month supply and require a 30% coinsurance at standard pharmacies.
Additional Benefits
The Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) plan offers comprehensive medical coverage with clear cost-sharing, featuring a $300 copay and no coinsurance for inpatient hospital stays. For routine care, members pay no copay for preventive services, a $10 copay for primary care, and a $45 copay for specialist visits. Outpatient hospital services and emergency room visits are also covered with no coinsurance, requiring copays ranging from no copay up to $150. This plan also includes dental, vision, and hearing benefits, offering routine exams for a $25 copay and no copay for prescription eyewear and hearing aids up to specified allowance maximums. While home health services require no copay and no coinsurance, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay. Note that certain supplemental benefits, such as routine transportation, fitness programs, and over-the-counter items, are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO), requiring a $300 copay per stay and no coinsurance for both acute and psychiatric admissions. Prior authorization is required, and while unlimited additional days are covered at no copay, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require prior authorization and have a copay ranging from $0 to $150, while individual and group outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance per service, although prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within three days. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency services are covered up to a $20,000 maximum with no coinsurance and copays of $50 for urgent care, $150 for emergency care, and $300 for emergency transportation.
Primary Care See details
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) covers primary care and professional services with no coinsurance, featuring a $10 copay for primary care and routine chiropractic visits and a $45 copay for specialists. Physical, occupational, and speech therapies require a $30 copay, while mental health sessions have a $35 copay and opioid treatment services are covered with no copay.
Preventive Services See details
Preventive Services under the Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) are partially covered, offering annual physical exams, kidney disease education, and other screenings with no copay and no coinsurance. While therapeutic massage is available for a $10 copay and no coinsurance, other options like fitness benefits, health education, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO), which offers routine hearing exams for a $25 copay and no coinsurance, and prescription hearing aids with no copay and no coinsurance up to a $1,500 maximum every two years. Fitting and evaluation for hearing aids, OTC hearing aids, and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) covers vision services, including annual routine eye exams and refractions for a $25 copay and no coinsurance. Eyewear is also covered with no copay and no coinsurance, providing a $300 combined maximum annual benefit for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered under Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO), with no coverage for other preventive dental services, maxillofacial prosthetics, and orthodontics. Medicare-covered dental has a $45 copay and no coinsurance, while other covered services feature no copay and no coinsurance up to a $600 annual maximum, except for implants and prosthodontics which require a 50% coinsurance and no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) covers dialysis services with no copayment and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO), offering no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Prior authorization is required for certain benefits, and diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required for diagnostic services. Covered services require a $10 copay for lab services, diagnostic procedures, and outpatient X-rays, a minimum $45 copay for therapeutic radiological services, and a minimum $75 copay for diagnostic radiological services.
Home Health Services See details
Home health services are covered under the Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) covers unlimited cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services. Eligible members will pay a $20 copayment per session with no coinsurance for these covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $200 copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are not covered under the Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) plan, meaning there is no coverage or benefit provided for acupuncture, over-the-counter (OTC) items, or meals.
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