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UW Health 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 UW Health 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 UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) in 2026, please refer to our full plan details page.
UW Health 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 Dane County. 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 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:
UW Health 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 UW Health 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 UW Health 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 $5.00. 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:
Sign up for UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP)
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 Dual Eligible (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay a 25% coinsurance for standard pharmacy and standard mail order prescriptions across Tier 1 preferred generics, Tier 2 generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs. This 25% coinsurance also applies to Tier 5 specialty drugs for a one-month supply at standard pharmacies. Additionally, Tier 6 select care drugs are available with no copay for one-month, two-month, and three-month supplies filled through standard pharmacies and standard mail order. This Medicare Advantage plan provides structured prescription drug coverage designed to help dual-eligible beneficiaries manage their healthcare costs.
Additional Benefits
The UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) offers comprehensive medical coverage featuring no copays for inpatient hospital stays, home health services, and primary care visits. While there are no copays for most of these core services, a 20% coinsurance applies to outpatient procedures, specialist visits, emergency care, and durable medical equipment. Fortunately, inpatient hospital stays and home health services require prior authorization but charge no coinsurance. This plan also includes valuable supplemental benefits, such as dental coverage up to a $3,000 annual limit with no copay or coinsurance for most preventive services. Additionally, members receive a $325 quarterly over-the-counter allowance and up to $3,000 for prescription hearing aids every two years with no copay or coinsurance. Unlimited one-way transportation to health-related locations is also provided with no copay and no coinsurance.
Inpatient Hospital See details
UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, although prior authorization is required. The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under the UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) with no copay, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for outpatient hospital services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization services are covered by the UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) with no copay and either no coinsurance or a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) covers ambulance and transportation services, requiring a 20% coinsurance and no copay for both ground and air ambulance trips. Unlimited one-way transportation to any health-related location is provided with no copay and no coinsurance, though transportation to plan-approved locations is not covered.
Emergency Services See details
UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, up to a maximum of $20 per visit. Worldwide emergency and urgent services are partially covered up to a $20,000 limit with a 20% coinsurance and no copay, but worldwide emergency transportation is not covered.
Primary Care See details
UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance. Chiropractic care is partially covered, offering up to 6 routine visits per year with no copay and 20% coinsurance, though other chiropractic services are not covered.
Preventive Services See details
UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) offers partially covered preventive services with no copays, though a 20% coinsurance applies to annual physical exams, medical nutrition therapy, glaucoma screenings, diabetes self-management, digital rectal exams, and EKGs. Kidney disease education features no copay and no coinsurance, but non-covered services include health education, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, post-discharge medication reconciliation, chemotherapy wigs, and home safety modifications.
Hearing Services See details
Hearing services are partially covered under the UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) plan, offering routine hearing exams once per year with no copay, no deductible, and a 20% coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to a $3,000 maximum benefit every two years, but 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
UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) offers partially covered vision services with no copays, featuring 20% coinsurance for contact lenses and one annual routine eye exam, while other eye exam services are not covered. Covered eyewear benefits, including lenses, frames, and upgrades, have no deductible and are subject to a combined maximum plan limit of $500 per year.
Dental Services See details
Dental services are partially covered by the UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) up to a $3,000 annual limit, featuring no copay and no coinsurance for most preventive and comprehensive care. Medicare-covered dental services require no copay and a 20% coinsurance, while prosthodontics and implants require no copay and a 50% coinsurance. Other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) with no copay, though prior authorization and step therapy may apply. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for durable medical equipment and prosthetics, and manufacturer limitations apply to diabetic supplies and durable medical equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) with no copay, but a minimum 20% coinsurance applies to Medicare-covered diagnostic procedures, lab services, X-rays, and radiological therapies. Prior authorization is required for all diagnostic services.
Home Health Services See details
UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) features no copay for Cardiac Rehabilitation Services, but only some services are covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) with no copay, though Medicare-defined coinsurance applies and prior authorization is required. This benefit requires a prior three-day inpatient hospital stay, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) partially covers other services, offering 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.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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