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Gundersen Quartz Med Advantage Core 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 Core 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 Core D (w/Rx) (HMO) in 2026, please refer to our full plan details page.
Gundersen Quartz Med Advantage Core 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 Core 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 Core 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 Core D (w/Rx) (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. 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 $270.00 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 $5900.00 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 Core D (w/Rx) (HMO) plan features an annual drug deductible of $270. Under this plan, you will enjoy no copay for Tier 6 Select Care Drugs when using standard pharmacies or standard mail order. For other generic medications, Tier 1 Preferred Generics require standard copays ranging from $2.00 to $5.00, while Tier 2 Generics cost between $10.00 and $25.00 depending on the supply fill. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 Preferred Brand drugs require a 20% coinsurance, while Tier 4 Non-Preferred drugs carry a 40% coinsurance for standard pharmacy and mail order fills. Tier 5 Specialty Tier drugs are limited to a one-month supply and require a 30% coinsurance.
Additional Benefits
The Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) plan offers robust medical coverage featuring fixed copayments and no coinsurance for most standard services. For inpatient hospital stays, members pay a $270 daily copay for days one through six and no copay for additional days, while primary care visits require a $25 copay and specialist visits cost $60. Emergency room visits carry a $130 copay, which is waived upon admission, and urgent care is available for a $50 copay. This plan also features valuable dental, vision, and hearing benefits, including routine dental cleanings and exams with no copay up to a $400 annual maximum. Routine eye and hearing exams require a $40 copay, while prescription eyewear and hearing aids are covered with no copay up to specified plan limits. Additionally, home health services are available with no copay, while dialysis and durable medical equipment require a 20% coinsurance.
Inpatient Hospital See details
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $270 daily copay for days 1 through 6 and no copay for days 7 and beyond. Prior authorization is required, and non-Medicare-covered stays and acute hospital upgrades are not covered.
Outpatient Services See details
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require prior authorization and have a copay ranging from $0 to $350, while outpatient substance abuse sessions carry a $50 copay.
Partial Hospitalization See details
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) covers partial hospitalization with either no copay or a $55 copay, and no coinsurance. Prior authorization is required for the services that charge a copay.
Ambulance and Transportation Services See details
Ambulance services are covered by Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) with a $300 copay and no coinsurance for both ground and air transport, though prior authorization is required. Although transportation services are technically covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if admitted to the hospital within 3 days, and urgent care with a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance up to a $20,000 maximum, featuring copays of $130, $50, and $300 respectively.
Primary Care See details
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) covers primary care visits with a $25 copay and specialist visits with a $60 copay, both with no coinsurance. Other covered benefits include physical and occupational therapy for a $45 copay, mental health services for a $50 copay, and routine chiropractic care for a $15 copay, all with no coinsurance.
Preventive Services See details
Preventive services are covered by Gundersen Quartz Med Advantage Core D (w/Rx) (HMO), offering annual physical exams and kidney disease education with no copay and no coinsurance. Additional benefits are partially covered, including therapeutic massage with a $25 copay and no coinsurance, while fitness benefits, health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Gundersen Quartz Med Advantage Core D (w/Rx) (HMO), featuring routine hearing exams for a $40 copay and no coinsurance, and prescription hearing aids with no copay or coinsurance up to a $1,000 limit every two years. Hearing aid fitting and evaluations, OTC hearing aids, and inner, outer, or over-the-ear prescription aid types are not covered.
Vision Services See details
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) covers routine and refraction eye exams with a $40 copay and no coinsurance. Eyewear, including contacts and eyeglasses, is covered with no copay or coinsurance up to a $150 annual maximum.
Dental Services See details
Dental services are partially covered by Gundersen Quartz Med Advantage Core D (w/Rx) (HMO), with Medicare-covered dental requiring a $60 copay and no coinsurance. Other covered services, such as cleanings, exams, and endodontics, have no copay and no coinsurance up to a $400 annual maximum, while implants and prosthodontics require no copay and a 50% coinsurance. Orthodontics, maxillofacial prosthetics, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while other Part B chemotherapy and radiation drugs carry a 0% to 20% coinsurance with no copay.
Dialysis Services See details
Dialysis services are covered under the Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) partially covers medical equipment with no copay and 20% coinsurance for durable medical equipment, prosthetics, and diabetic therapeutic shoes. Diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) with no coinsurance for all services. Members will pay a $20 copay for outpatient X-rays, lab services, and diagnostic procedures, while therapeutic radiological services have a minimum copay of $75 and diagnostic radiological services have a minimum copay of $225.
Home Health Services See details
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) with no coinsurance for all programs. These unlimited services require a $30 copay for cardiac and intensive cardiac rehabilitation, a $15 copay for pulmonary rehabilitation, and a $25 copay for supervised exercise therapy (SET) for peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $215 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered by the Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage. Consequently, there are no copays or coinsurance options available, and members must pay the full cost for these services out of pocket.
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