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Gundersen Quartz Med Advantage Elite (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gundersen Quartz Med Advantage Elite (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 (HMO) in 2026, please refer to our full plan details page.
Gundersen Quartz Med Advantage Elite (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 (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 Elite (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 (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 $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
Prescription drugs are not covered by Gundersen Quartz Med Advantage Elite (HMO).
Additional Benefits
The Gundersen Quartz Med Advantage Elite (HMO) plan offers predictable costs for core medical services, featuring no coinsurance for most standard care. Members pay a $10 copay for primary care visits, a $45 copay for specialists, and a $300 copay per stay for inpatient hospital services with no coinsurance. Emergency care is available with a $150 copay, while outpatient hospital services range from no copay to a $150 copay. For supplemental care, the plan provides routine vision and hearing exams for a $25 copay, alongside allowances of $300 for eyewear and $1,500 every two years for hearing aids. Most covered dental services have no copay up to a $1,000 annual limit, and home health care is available with no copay and no coinsurance. Additionally, durable medical equipment and dialysis services require no copay but carry a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Gundersen Quartz Med Advantage Elite (HMO) with a $300 copay per stay and no coinsurance, though prior authorization is required. This benefit is partially covered, as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Gundersen Quartz Med Advantage Elite (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $150 and substance abuse sessions with a $35 copay. Ambulatory surgical center and outpatient blood services are also covered with no copay and no coinsurance.
Partial Hospitalization See details
Gundersen Quartz Med Advantage Elite (HMO) covers partial hospitalization with no copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Gundersen Quartz Med Advantage Elite (HMO), where ground and air ambulance services require prior authorization, a $300 copay, and no coinsurance. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Gundersen Quartz Med Advantage Elite (HMO) covers emergency services with a $150 copay (waived if admitted to the hospital within 3 days) and no coinsurance, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $20,000 maximum benefit with no coinsurance and copays of $150, $50, and $300 respectively.
Primary Care See details
Gundersen Quartz Med Advantage Elite (HMO) covers primary care physician visits with a $10 copay and specialist visits with a $45 copay, both with no coinsurance. Additional services like therapy, chiropractic, and mental health care have copays ranging from $10 to $45 with no coinsurance, while telehealth options carry a $0 to $50 copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Gundersen Quartz Med Advantage Elite (HMO) with no copay and no coinsurance for covered services like annual physicals, kidney disease education, and therapeutic massage. Several additional services are not covered, including health education, fitness benefits, weight management programs, alternative therapies, in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, chemotherapy wigs, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, extra smoking cessation, enhanced disease management, telemonitoring, and home safety modifications.
Hearing Services See details
Gundersen Quartz Med Advantage Elite (HMO) partially covers hearing services, offering routine hearing exams with a $25 copay and no coinsurance, while fitting and evaluation exams are not covered. Prescription hearing aids are covered with no copay and no coinsurance up to a $1,500 maximum limit every two years, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Gundersen Quartz Med Advantage Elite (HMO) covers vision services with no deductibles, offering annual routine eye and refraction exams for a $25 copay and no coinsurance. Eyewear, including contacts, frames, lenses, and upgrades, is also covered with no copay and no coinsurance up to a $300 annual maximum.
Dental Services See details
Dental Services are partially covered by Gundersen Quartz Med Advantage Elite (HMO), with Medicare-covered services requiring a $45 copay and no coinsurance, and most other covered services having no copay and no coinsurance up to a $1,000 annual maximum. Prosthodontics and implants require no copay and 50% coinsurance, while other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Gundersen Quartz Med Advantage Elite (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 other Part B chemotherapy, radiation, and miscellaneous drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Gundersen Quartz Med Advantage Elite (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Gundersen Quartz Med Advantage Elite (HMO) covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes. While most medical equipment is covered, diabetic supplies are not covered, and prior authorization is required for durable medical equipment and prosthetics.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Gundersen Quartz Med Advantage Elite (HMO) with no coinsurance. Members pay a $10 copay for outpatient X-rays, lab services, and diagnostic procedures, a minimum $45 copay for therapeutic radiological services, and a minimum $100 copay for diagnostic radiological services.
Home Health Services See details
Gundersen Quartz Med Advantage Elite (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Gundersen Quartz Med Advantage Elite (HMO) covers unlimited cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services. These covered services require a $20 copay and have no coinsurance.
Skilled Nursing Facility (SNF) See details
Gundersen Quartz Med Advantage Elite (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $200 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 the Gundersen Quartz Med Advantage Elite (HMO) plan, including acupuncture, over-the-counter (OTC) items, and meal benefits.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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