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UW Health Quartz Med Advantage Value D (w/Rx) (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UW Health Quartz Med Advantage Value 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 UW Health Quartz Med Advantage Value D (w/Rx) (HMO) in 2026, please refer to our full plan details page.
UW Health Quartz Med Advantage Value 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 Counties: Dane, Columbia, Green. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that UW Health Quartz Med Advantage Value 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 UW Health Quartz Med Advantage Value 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 UW Health Quartz Med Advantage Value D (w/Rx) (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $106.00. 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 $225.00 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 $4900.00 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 UW Health Quartz Med Advantage Value D (w/Rx) (HMO) plan features an annual drug deductible of $225. Under this plan, Tier 6 Select Care Drugs are available with no copay for standard pharmacy and mail-order fills of any duration. For other generic medications, you will pay a low $2.00 copay for Tier 1 Preferred Generics and a $10.00 copay for Tier 2 Generics on a standard 1-month supply. Brand-name and specialty medications are covered under coinsurance rates rather than flat copays. Tier 3 Preferred Brands require a 20% coinsurance, while Tier 4 Non-Preferred Drugs require 40% coinsurance for standard fills. Tier 5 Specialty Tier drugs are available with a 30% coinsurance for a 1-month supply at standard pharmacies.
Additional Benefits
The UW Health Quartz Med Advantage Value D (w/Rx) (HMO) plan offers predictable medical costs, featuring no coinsurance for primary care, specialist, and hospital services. Primary care doctor visits require a $15 copay, specialist visits cost $50, and inpatient hospital stays have a $225 daily copay for the first six days followed by no copay. Emergency care is covered with a $130 copay, which is waived if you are admitted to the hospital within three days. This plan also provides strong coverage for everyday wellness, including routine dental, vision, and hearing services. Routine vision and hearing exams require a $35 copay, but the plan offers no copay for eyewear up to a $250 annual limit and prescription hearing aids up to $1,250 every two years. Additionally, most preventive dental services and home health visits are available with no copay.
Inpatient Hospital See details
Inpatient hospital care is partially covered by UW Health Quartz Med Advantage Value D (w/Rx) (HMO) with no coinsurance and a $225 daily copay for days 1 through 6, followed by no copay for days 7 and beyond. While acute and psychiatric stays are covered, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
UW Health Quartz Med Advantage Value D (w/Rx) (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services at no copay. Outpatient hospital services require prior authorization with a copay ranging from $0 to $350, while individual and group outpatient substance abuse sessions have a $40 copay and no coinsurance.
Partial Hospitalization See details
The UW Health Quartz Med Advantage Value D (w/Rx) (HMO) plan covers partial hospitalization services with either no copay or a $55 copay, and no coinsurance. Prior authorization is required for the services that incur the $55 copay.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by UW Health Quartz Med Advantage Value D (w/Rx) (HMO), requiring prior authorization with a $300 copay and no coinsurance for ground and air ambulance services. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by the UW Health Quartz Med Advantage Value D (w/Rx) (HMO) plan with a $130 copay, which is waived if admitted to the hospital within 3 days, and no coinsurance. Urgently needed services require a $45 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $45 to $300 up to a $20,000 maximum benefit.
Primary Care See details
UW Health Quartz Med Advantage Value D (w/Rx) (HMO) covers primary care doctor visits for a $15 copay and no coinsurance, and specialist visits for a $50 copay and no coinsurance. Other services like chiropractic care, physical therapy, and mental health sessions have copays ranging from $15 to $50 and no coinsurance, while opioid treatment is available with no copay and no coinsurance.
Preventive Services See details
UW Health Quartz Med Advantage Value D (w/Rx) (HMO) preventive services are partially covered, offering annual physical exams, kidney disease education, and other preventive services with no copay and no coinsurance. While therapeutic massage is covered with a $10 copay and no coinsurance, and counseling and fitness benefits are covered with no copay and no coinsurance, sub-services such as health education, in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, wigs, weight management, alternative therapies, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, and home safety modifications are not covered.
Hearing Services See details
Hearing services are partially covered by UW Health Quartz Med Advantage Value D (w/Rx) (HMO), offering routine exams for a $35 copay and no coinsurance, and prescription hearing aids with no copay or coinsurance up to a $1,250 limit every two years. Fitting and evaluation, OTC hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by the UW Health Quartz Med Advantage Value D (w/Rx) (HMO) plan, offering routine and refraction eye exams for a $35 copay and no coinsurance once per year. Covered eyewear, including lenses, frames, and contact lenses, has no copay and no coinsurance up to a $250 combined annual maximum limit.
Dental Services See details
Dental services are partially covered by UW Health Quartz Med Advantage Value D (w/Rx) (HMO), featuring a $50 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for most other covered services up to a $475 yearly limit. Removable prosthodontics, fixed prosthodontics, and implants require a 50% coinsurance and no copay, while other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
UW Health Quartz Med Advantage Value D (w/Rx) (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the UW Health Quartz Med Advantage Value D (w/Rx) (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by the UW Health Quartz Med Advantage Value D (w/Rx) (HMO), featuring no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are not covered under this plan, and prior authorization is required for durable medical equipment and prosthetics.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the UW Health Quartz Med Advantage Value D (w/Rx) (HMO) plan with no coinsurance. Members pay a $20 copay for diagnostic procedures, tests, and lab services, a $30 copay for outpatient X-rays, and minimum copays of $75 for therapeutic radiological services and $175 for diagnostic radiological services.
Home Health Services See details
Home Health Services are covered under the UW Health Quartz Med Advantage Value D (w/Rx) (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by UW Health Quartz Med Advantage Value D (w/Rx) (HMO) with no coinsurance and a $25 copay for cardiac, intensive cardiac, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services. Pulmonary rehabilitation services are also covered under this plan with no coinsurance and a $15 copay.
Skilled Nursing Facility (SNF) See details
UW Health Quartz Med Advantage Value D (w/Rx) (HMO) covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and a $215 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered under the UW Health Quartz Med Advantage Value D (w/Rx) (HMO) plan, which features over-the-counter (OTC) items with no copay and no coinsurance up to a $15 limit every three months. Acupuncture and meal benefits are not covered under this plan.
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