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Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP). 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 Dual Eligible (HMO D-SNP) in 2026, please refer to our full plan details page.
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) is a HMO D-SNP plan offered by University of Wisconsin Hospitals and Clincs Autho available for enrollment in 2026 to people living in La Crosse County. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP).
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 Dual Eligible (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.10. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.70. You must continue to pay paying your reduced 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 $615.00 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 $9250.00 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 Dual Eligible (HMO D-SNP) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics, Tier 2 generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs, beneficiaries pay a 25% coinsurance for 1-month, 2-month, and 3-month supplies at standard pharmacies and through standard mail order. Tier 5 specialty tier drugs also carry a 25% coinsurance for a 1-month supply at standard pharmacies. For Tier 6 select care drugs, the plan offers no copay for 1-month, 2-month, and 3-month supplies at standard pharmacies and through standard mail order. Knowing these specific coinsurance rates and deductible requirements helps you accurately plan your prescription drug costs with this Gundersen Quartz Medicare Advantage plan.
Additional Benefits
The Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) offers robust medical coverage with no copay for the majority of its services. Inpatient hospital stays, home health care, and skilled nursing facility services are covered with no copay and no coinsurance. Most outpatient services, primary care visits, emergency care, and medical equipment require no copay and a 20% coinsurance. This plan also provides valuable supplemental benefits, including up to $3,000 annually for covered dental services and $500 for eyewear with no copay. Hearing aids are covered up to $3,000 every two years with no copay and no coinsurance, alongside a $325 quarterly allowance for over-the-counter items. Members can also utilize unlimited one-way rides to health-related locations via rideshare or public transit with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) with no copay and no coinsurance for covered acute and psychiatric stays, subject to prior authorization. Unlimited additional days for acute care are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) covers outpatient services—including outpatient hospital, ambulatory surgical center, substance abuse, and blood services—with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) covers partial hospitalization with no copay and either no coinsurance or 20% coinsurance. Prior authorization is required for services that incur the 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered, offering unlimited one-way rides to any health-related location via rideshare or bus/subway with no copay and no coinsurance, while plan-approved health-related location transportation is not covered.
Emergency Services See details
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) covers emergency and urgently needed services with no copay and a 20% coinsurance, up to a maximum of $20 per visit. Worldwide emergency and urgent services are partially covered up to a $20,000 maximum with no copay and 20% coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance. Chiropractic services are partially covered, providing up to 6 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) with no copay for all covered services, but a 20% coinsurance applies to the annual physical exam, medical nutrition therapy, glaucoma screenings, diabetes training, digital rectal exams, and EKGs. Kidney disease education is offered with no copay and no coinsurance, while services such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) partially covers hearing services, offering routine hearing exams once per year with no copay and a 20% coinsurance. Prescription hearing aids are covered up to $3,000 every two years with no copay and no coinsurance, but fitting and evaluation, OTC hearing aids, and inner, outer, or over-the-ear hearing aid types are not covered.
Vision Services See details
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) partially covers vision services with no copays, though a 20% coinsurance applies to routine eye exams and contact lenses. The plan includes one routine eye exam and up to $500 annually for eyewear with no deductible, but other eye exam services are not covered.
Dental Services See details
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) offers partially covered dental services, excluding orthodontics, maxillofacial prosthetics, and other preventive dental services. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered dental services have no copay and no coinsurance up to a $3,000 annual maximum, except for implants and prosthodontics which require a 50% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) with no copay, though prior authorization is required. Medicare Part B insulin drugs carry a $35 copay with no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) covers durable medical equipment, prosthetics, and diabetic supplies with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics, and coverage for certain items may be limited to preferred vendors or manufacturers.
Diagnostic and Radiological Services See details
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance. Prior authorization is required for diagnostic procedures, tests, and lab services, while radiological services, including therapeutic radiology and outpatient X-rays, also carry a 20% coinsurance and no copay.
Home Health Services See details
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to access these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) with no copay, though specific sub-services including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a three-day inpatient hospital stay are required. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) partially covers other services, providing acupuncture with a $20 copay and no coinsurance for up to 6 treatments per year, and over-the-counter items with no copay and no coinsurance up to a $325 limit every three months. Meal benefits and other additional services are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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