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UW Health Quartz Med Advantage Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UW Health 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 UW Health Quartz Med Advantage Value (HMO) in 2026, please refer to our full plan details page.
UW Health 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 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 (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 UW Health 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 UW Health 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 $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
Prescription drugs are not covered by UW Health Quartz Med Advantage Value (HMO).
Additional Benefits
The UW Health Quartz Med Advantage Value (HMO) plan offers comprehensive medical coverage with predictable costs, featuring a $15 copay for primary care visits, a $40 copay for specialists, and no copay for standard preventive services. Emergency room visits require a $130 copay, while inpatient hospital stays have a $200 daily copay for the first six days and no copay thereafter, all with no coinsurance. Outpatient hospital services and diagnostic procedures are also covered with no coinsurance, requiring copays that range from no copay up to $300 depending on the service. This plan also includes valuable supplemental benefits, such as dental coverage up to a $2,000 annual limit and eyewear up to $300 annually with no copay, alongside routine hearing and vision exams for a $35 copay. Skilled nursing facility stays feature no copay for the first 20 days, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Additionally, members receive a $30 quarterly over-the-counter allowance with no copay or coinsurance to help cover everyday health needs.
Inpatient Hospital See details
UW Health Quartz Med Advantage Value (HMO) partially covers inpatient acute and psychiatric hospital services with no coinsurance, requiring prior authorization and a $200 daily copay for days 1 through 6, with no copay for days 7 and beyond. This benefit is partially covered because non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by the UW Health Quartz Med Advantage Value (HMO) with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $40 copay for individual and group substance abuse sessions. Ambulatory surgical center and outpatient blood services are also covered with no copays and no coinsurance.
Partial Hospitalization See details
UW Health Quartz Med Advantage Value (HMO) covers partial hospitalization services with either no copay or a $55 copay, and no coinsurance. Prior authorization is required for services requiring a copay.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the UW Health Quartz Med Advantage Value (HMO) plan, featuring a $275 copay and no coinsurance for both ground and air ambulance services, which require prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
UW Health Quartz Med Advantage Value (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within three days, and urgently needed services with a $45 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $20,000 maximum benefit with no coinsurance, featuring copays of $130, $45, and $275 respectively.
Primary Care See details
UW Health Quartz Med Advantage Value (HMO) covers primary care visits for a $15 copay and specialist visits for a $40 copay, with no coinsurance required for either. Additional services like physical therapy, mental health, and telehealth are covered with copays ranging from $0 to $50 and no coinsurance, though select therapies require prior authorization.
Preventive Services See details
UW Health Quartz Med Advantage Value (HMO) partially covers preventive services, offering annual physical exams, kidney disease education, and other standard screenings with no copay and no coinsurance. While therapeutic massage is covered with a $10 copay and no coinsurance, other supplemental services such as health education, weight management programs, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by the UW Health Quartz Med Advantage Value (HMO) plan, which offers one routine hearing exam annually for a $35 copay and no coinsurance. Prescription hearing aids are covered with no copay and no coinsurance up to a $1,500 maximum every two years, though hearing aid fittings, OTC devices, and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by UW Health Quartz Med Advantage Value (HMO), offering annual routine eye exams and refractions for a $35 copay and no coinsurance. Eyewear, including contacts and glasses, is covered with no copay, no coinsurance, and no deductible up to a $300 annual maximum.
Dental Services See details
UW Health Quartz Med Advantage Value (HMO) partially covers dental services up to a $2,000 annual maximum, with Medicare-covered dental requiring a $40 copay and no coinsurance, and most preventive and restorative services requiring no copay and no coinsurance. Implants and prosthodontics are covered with no copay and 50% coinsurance, while other preventive dental, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the UW Health Quartz Med Advantage Value (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UW Health Quartz Med Advantage Value (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
UW Health Quartz Med Advantage Value (HMO) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts with no copay and 20% coinsurance, though prior authorization may be required. This benefit is partially covered because diabetic supplies are not covered, and coverage is limited to specified manufacturers and preferred vendors.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the UW Health Quartz Med Advantage Value (HMO) with no coinsurance. Diagnostic procedures, tests, and lab services require a $20 copay, while radiological services require a $30 copay for X-rays, a minimum $75 copay for therapeutic radiology, and a minimum $150 copay for diagnostic radiology.
Home Health Services See details
Home health services are covered by the UW Health Quartz Med Advantage Value (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
UW Health Quartz Med Advantage Value (HMO) covers cardiac rehabilitation services with no coinsurance, requiring a $25 copay per session for cardiac, intensive cardiac, and SET for PAD services, and a $15 copay per session for pulmonary rehabilitation. These covered rehabilitation benefits are unlimited.
Skilled Nursing Facility (SNF) See details
UW Health Quartz Med Advantage Value (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20 and a $215 daily copay for days 21 through 100, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
UW Health Quartz Med Advantage Value (HMO) partially covers Other Services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $30 every three months. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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