A non-government entity
UW Health 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 UW Health 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 UW Health Quartz Med Advantage Core D (w/Rx) (HMO) in 2026, please refer to our full plan details page.
UW Health 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 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 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 UW Health 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 UW Health Quartz Med Advantage Core D (w/Rx) (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.00. 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 $5400.00 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:
Sign up for UW Health Quartz Med Advantage Core D (w/Rx) (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The UW Health Quartz Med Advantage Core D (w/Rx) (HMO) plan features a $270 annual drug deductible. For Tier 6 select care drugs, you will pay no copay for one-month, two-month, or three-month supplies through standard pharmacies and mail order. Tier 1 preferred generic drugs require a low standard copay starting at $2.00, while Tier 2 generic drug copays start at $10.00. For higher-tier prescriptions, standard pharmacy and mail-order costs transition to a coinsurance model. You will pay a 20% coinsurance for Tier 3 preferred brand drugs and a 40% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The UW Health Quartz Med Advantage Core D (w/Rx) (HMO) plan offers robust medical coverage with predictable copays and no coinsurance for many primary services. Members pay a $20 copay for primary care visits, a $65 copay for specialists, and no copay for most preventive care. Inpatient hospital stays require a $270 daily copay for the first seven days, while emergency room visits carry a $130 copay that is waived if admitted. Specialty benefits include routine vision and hearing exams for a $40 copay, with no copay for eyewear up to a $150 annual limit and prescription hearing aids up to a $1,000 limit every two years. Dental care is also covered with no copay for most preventive and comprehensive services up to a $400 annual limit. Additionally, skilled nursing facility stays feature no copay for the first 20 days, while medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
UW Health Quartz Med Advantage Core D (w/Rx) (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $270 daily copay for days 1 through 7 and no copay for days 8 and beyond. This benefit is partially covered because non-Medicare-covered stays and hospital upgrades are not covered, and prior authorization is required.
Outpatient Services See details
UW Health Quartz Med Advantage Core D (w/Rx) (HMO) covers outpatient hospital services with a $0 to $400 copay (prior authorization required) and no coinsurance, while ambulatory surgical and outpatient blood services have no copay and no coinsurance. Outpatient substance abuse individual and group sessions are covered with a $50 copay and no coinsurance.
Partial Hospitalization See details
The UW Health Quartz Med Advantage Core D (w/Rx) (HMO) plan covers partial hospitalization services with no coinsurance. Depending on the specific service, you will pay either no copay or a $55 copay, and prior authorization may be required.
Ambulance and Transportation Services See details
UW Health Quartz Med Advantage Core D (w/Rx) (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance, although prior authorization is required. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
UW Health Quartz Med Advantage Core D (w/Rx) (HMO) covers emergency services with a $130 copay (waived if admitted within 3 days) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $50 to $300, up to a $20,000 maximum plan benefit limit.
Primary Care See details
Primary care and specialist services are covered by UW Health Quartz Med Advantage Core D (w/Rx) (HMO) with a $20 and $65 copay respectively, and no coinsurance. Additional covered benefits include therapy, psychiatric, and chiropractic services with copays ranging from $15 to $50 and no coinsurance, while opioid treatment features no copay and no coinsurance.
Preventive Services See details
UW Health Quartz Med Advantage Core D (w/Rx) (HMO) covers most preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance, while therapeutic massage is covered with a $15 copay and no coinsurance. However, these additional preventive services are only partially covered, as health education, fitness benefits, weight management, in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, wigs, 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
UW Health Quartz Med Advantage Core D (w/Rx) (HMO) partially covers hearing services, offering one annual routine hearing exam for a $40 copay and no coinsurance, as well as up to two prescription hearing aids every two years with no copay or coinsurance up to a $1,000 limit. Hearing aid fittings and evaluations, OTC hearing aids, and inner ear, outer ear, and over-the-ear prescription hearing aid types are not covered.
Vision Services See details
UW Health Quartz Med Advantage Core D (w/Rx) (HMO) covers annual routine and refraction eye exams with a $40 copay and no coinsurance. Eyewear, including contacts, frames, lenses, and upgrades, is covered with no copay, no coinsurance, and no deductible up to a $150 maximum benefit limit per year.
Dental Services See details
UW Health Quartz Med Advantage Core D (w/Rx) (HMO) provides partially covered dental services, featuring Medicare-covered dental with a $65 copay and no coinsurance. Most preventive and comprehensive services have no copay and no coinsurance up to a $400 annual limit, while prosthodontics and implants carry no copay and 50% coinsurance; orthodontics, maxillofacial prosthetics, and other preventive dental services are not covered.
Home Infusion bundled Services See details
UW Health Quartz Med Advantage Core D (w/Rx) (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy may apply. Under this benefit, 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 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the UW Health Quartz Med Advantage Core D (w/Rx) (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
UW Health Quartz Med Advantage Core D (w/Rx) (HMO) covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic equipment is partially covered, as diabetic supplies are not covered, and certain items require prior authorization or are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UW Health Quartz Med Advantage Core D (w/Rx) (HMO) with no coinsurance, although prior authorization is required for diagnostic services. Members pay a $25 copay for diagnostic tests and lab services, a $35 copay for outpatient x-rays, an $80 copay for therapeutic radiology, and a $250 copay for diagnostic radiological services.
Home Health Services See details
UW Health Quartz Med Advantage Core D (w/Rx) (HMO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered with no coinsurance under the UW Health Quartz Med Advantage Core D (w/Rx) (HMO) plan, which offers unlimited sessions for all covered therapy types. Patients will pay 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.
Skilled Nursing Facility (SNF) See details
UW Health Quartz Med Advantage Core D (w/Rx) (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $215 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
Other Services are not covered under the UW Health Quartz Med Advantage Core D (w/Rx) (HMO) plan, meaning acupuncture, over-the-counter (OTC) items, and meal benefits are excluded from coverage with no copay or coinsurance options available.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved