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Gundersen Quartz Med Advantage Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gundersen Quartz Med Advantage Value (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 Value (HMO) in 2026, please refer to our full plan details page.
Gundersen Quartz Med Advantage Value (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 Value (HMO) 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 Gundersen Quartz Med Advantage Value (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 Value (HMO), 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 Maximum Out-Of-Pocket cost of $4200.00 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
Prescription drugs are not covered by Gundersen Quartz Med Advantage Value (HMO).
Additional Benefits
The Gundersen Quartz Med Advantage Value (HMO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring a 15 dollar copay for primary care visits and a 50 dollar copay for specialists with no coinsurance. Inpatient hospital stays require a 225 dollar daily copay for the first six days and no copay thereafter, while home health services are covered with no copay and no coinsurance. Emergency care is also available with a 150 dollar copay, which is waived if you are admitted within three days. For ancillary care, this plan provides dental benefits up to a 1,000 dollar annual limit with no copay for most preventive treatments, alongside routine eye and hearing exams for a 35 dollar copay. Prescription hearing aids are covered with no copay up to a 1,500 dollar limit every two years, and eyewear is covered with no copay up to 225 dollars annually. Additionally, durable medical equipment and dialysis services are covered with no copay and a 20 percent coinsurance.
Inpatient Hospital See details
Gundersen Quartz Med Advantage Value (HMO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $225 copay per day for days 1 through 6 and no copay for days 7 and beyond. Prior authorization is required, and upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Gundersen Quartz Med Advantage Value (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services which also have no copay. Outpatient hospital services carry a copay of $0 to $200 with no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Gundersen Quartz Med Advantage Value (HMO) with no copay and no coinsurance. While these mental health services are fully covered, prior authorization may be required.
Ambulance and Transportation Services See details
Gundersen Quartz Med Advantage Value (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Gundersen Quartz Med Advantage Value (HMO) covers emergency services with a $150 copay (waived if admitted within 3 days) and urgently needed services with a $60 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $20,000 maximum limit with no coinsurance and copays of $150, $60, and $300 respectively.
Primary Care See details
Gundersen Quartz Med Advantage Value (HMO) covers primary care visits with a $15 copay and specialist visits with a $50 copay, with no coinsurance required for either. Additional services like physical therapy ($30 copay), mental health sessions ($40 copay), and opioid treatment (no copay) are also covered with no coinsurance.
Preventive Services See details
Preventive services are covered by Gundersen Quartz Med Advantage Value (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, and Medicare-covered preventive care. Additional preventive services are partially covered, including counseling and therapeutic massage for a $15 copay and no coinsurance, though benefits such as fitness programs, health education, and weight management are not covered.
Hearing Services See details
Gundersen Quartz Med Advantage Value (HMO) offers partially covered hearing services, including one routine hearing exam per year for a $35 copay and no coinsurance, while hearing aid fittings and evaluations are not covered. Prescription hearing aids are covered with no copay and no coinsurance up to a $1,500 maximum every two years, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Gundersen Quartz Med Advantage Value (HMO) vision services cover annual routine eye exams for a $35 copay and no coinsurance, plus annual refraction exams with no deductible. Eyewear, including contacts and glasses, is covered with no copay, no coinsurance, and no deductible up to a combined maximum benefit of $225 per year.
Dental Services See details
Gundersen Quartz Med Advantage Value (HMO) dental services are partially covered up to a $1,000 annual limit, featuring no copay or coinsurance for most preventive and comprehensive treatments, and a $50 copay with no coinsurance for Medicare-covered dental. Implants and prosthodontics require a 50% coinsurance and no copay, while orthodontics, maxillofacial prosthetics, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Gundersen Quartz Med Advantage Value (HMO) with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while Part B chemotherapy and other drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Gundersen Quartz Med Advantage Value (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by Gundersen Quartz Med Advantage Value (HMO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, though diabetic supplies are not covered. Prior authorization is required for durable medical equipment and prosthetics, and brand or vendor limitations may apply.
Diagnostic and Radiological Services See details
Gundersen Quartz Med Advantage Value (HMO) covers diagnostic and radiological services with no coinsurance. Diagnostic procedures, lab services, and outpatient X-rays require a $10 copay, while therapeutic radiological services have a $60 copay and diagnostic radiological services carry a $100 copay.
Home Health Services See details
Home Health Services are covered under the Gundersen Quartz Med Advantage Value (HMO) plan with no copay and no coinsurance. Prior authorization is required to access these benefits.
Cardiac Rehabilitation Services See details
Gundersen Quartz Med Advantage Value (HMO) covers unlimited cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services. These covered services require a $25 copayment and have no coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Gundersen Quartz Med Advantage Value (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $215 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered by Gundersen Quartz Med Advantage Value (HMO), meaning there is no plan coverage, copay, or coinsurance for acupuncture, over-the-counter (OTC) items, and meal benefits.
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