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UW Health Quartz Med Advantage Basic 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 Basic 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 Basic D (w/Rx) (HMO) in 2026, please refer to our full plan details page.
UW Health Quartz Med Advantage Basic 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 Basic 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 Basic 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 Basic D (w/Rx) (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.
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 $6400.00 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 UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) plan features an annual drug deductible of $270. Tier 6 select care drugs are fully covered with no copay for up to a three-month supply at standard pharmacies and through mail order. For other generic medications, you will pay a low $2 copay for Tier 1 preferred generics and a $10 copay for Tier 2 generics for a one-month supply. Higher-tier medications are subject to coinsurance rather than flat copays. Tier 3 preferred brands require a 20% coinsurance, and Tier 4 non-preferred drugs require a 40% coinsurance for both standard retail and mail-order options. Specialty medications in Tier 5 are available with a 30% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) plan offers comprehensive medical coverage featuring no coinsurance for many core services, including inpatient hospital stays, primary care, and emergency visits. Members pay a $300 daily copay for the first seven days of inpatient hospital stays, while primary care visits require a $25 copay and specialist visits cost $75. Emergency care is available with a $130 copay, which is waived if admitted, and urgent care has a $50 copay. Preventive care, home health services, and routine dental cleanings are covered with no copay and no coinsurance. Routine vision and hearing exams require a $40 copay, with allowances provided for eyewear and hearing aids. For specialized needs, dialysis services and durable medical equipment require a 20% coinsurance, while outpatient diagnostic procedures and X-rays carry a $50 copay.
Inpatient Hospital See details
UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 daily copay for days 1 to 7 and no copay for days 8 and beyond. This benefit is partially covered, as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
UW Health Quartz Med Advantage Basic 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 carry a copay of $0 to $450, while outpatient substance abuse sessions have a $60 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) plan with no coinsurance and copays ranging from no copay to $55. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance, subject to prior authorization. Transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within three days. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency services are covered up to a $20,000 maximum with no coinsurance and copays of $50 for urgent care, $130 for emergency care, and $300 for emergency transportation.
Primary Care See details
UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) covers primary care physician visits for a $25 copay and specialists for a $75 copay, both with no coinsurance. Other covered services under this benefit include physical, occupational, and speech therapy for a $50 copay, mental health sessions for a $60 copay, and opioid treatment with no copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered under the UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) with no copay and no coinsurance for covered healthcare. Excluded sub-services under this plan include fitness benefits, health education, weight management, personal emergency response systems, in-home safety assessments, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, post-discharge medication reconciliation, wigs, and home safety modifications.
Hearing Services See details
UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) hearing services are partially covered, offering annual routine hearing exams for a $40 copay and no coinsurance, while fitting and evaluation exams are not covered. For prescription hearing aids, some services are covered with no copay or coinsurance up to an $800 allowance every two years, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are covered by UW Health Quartz Med Advantage Basic D (w/Rx) (HMO), offering annual routine and refraction eye exams for a $40 copay and no coinsurance. Eyewear, including glasses and contacts, is covered with no copay or coinsurance up to a combined maximum plan benefit of $75 per year.
Dental Services See details
Dental services are partially covered by UW Health Quartz Med Advantage Basic D (w/Rx) (HMO), which offers Medicare-covered dental for a $75 copay and no coinsurance, and preventive services like annual exams and cleanings with no copay and no coinsurance. Non-covered services under this plan include restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, orthodontics, and other preventive or adjunctive services.
Home Infusion bundled Services See details
UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by the UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) plan, featuring no copay and a 20% coinsurance for durable medical equipment, prosthetics, and diabetic therapeutic shoes. While medical supplies are also covered at a 20% coinsurance, diabetic supplies are not covered, and some items may require prior authorization or be limited to preferred manufacturers.
Diagnostic and Radiological Services See details
UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) covers diagnostic and radiological services with no coinsurance. Members pay a $50 copay for diagnostic procedures, lab services, and outpatient X-rays, while therapeutic radiological services require a minimum $85 copay and diagnostic radiological services require a minimum $300 copay.
Home Health Services See details
UW Health Quartz Med Advantage Basic 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
UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) covers unlimited cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for PAD rehabilitation services with no coinsurance. Members will pay a $30 copay for cardiac and intensive cardiac rehab, a $15 copay for pulmonary rehab, and a $25 copay for SET for PAD services.
Skilled Nursing Facility (SNF) See details
UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) covers skilled nursing facility care with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $215 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Other Services are not covered under the UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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