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Aspirus Health Plan Elite (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aspirus Health Plan Elite (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aspirus Health Plan Elite (PPO) in 2026, please refer to our full plan details page.
Aspirus Health Plan Elite (PPO) is a PPO plan offered by Aspirus, Inc. available for enrollment in 2025 to people living in Central WI. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aspirus Health Plan Elite (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aspirus Health Plan Elite (PPO).
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 Aspirus Health Plan Elite (PPO), 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. Additionally, this plan comes with a Part B Premium reduction of $25.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $3200.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $3200.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Aspirus Health Plan Elite (PPO)
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Drug Coverage
Prescription drugs are not covered by Aspirus Health Plan Elite (PPO).
Additional Benefits
The Aspirus Health Plan Elite (PPO) offers comprehensive medical coverage with no copay or coinsurance for primary care visits and preventive services. For specialized medical care, members pay a $45 copay for specialist visits, a $300 copay per inpatient hospital admission, and a $195 copay for outpatient hospital services. Emergency and urgent care are highly accessible, featuring a $130 copay for emergency room visits and a $50 copay for urgent care. This plan also provides strong supplemental benefits, including covered dental exams, cleanings, and implants with no copay or coinsurance. Vision care includes a routine annual eye exam with a $0 to $40 copay and up to $175 annually for eyewear with no copay. Additionally, members benefit from no-copay home health services and an over-the-counter allowance of $75 every six months.
Inpatient Hospital See details
Aspirus Health Plan Elite (PPO) covers inpatient acute and psychiatric hospital stays with a $300 copayment per admission and no coinsurance. While unlimited additional days for acute care are covered with no copay, this plan does not cover psychiatric additional days, room upgrades, or non-Medicare-covered stays.
Outpatient Services See details
Aspirus Health Plan Elite (PPO) covers outpatient hospital and ambulatory surgical center services with a $195 copay and no coinsurance, while outpatient blood services are covered with no copay or coinsurance. Some outpatient substance abuse services are covered with no copay or coinsurance, though individual and group sessions are not covered.
Partial Hospitalization See details
Aspirus Health Plan Elite (PPO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are offered by Aspirus Health Plan Elite (PPO), which covers ground and air ambulance services with a $200 copay and no coinsurance. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Aspirus Health Plan Elite (PPO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent care are covered with a $130 copay, and worldwide emergency transportation is covered with a $100 copay, all with no coinsurance.
Primary Care See details
Aspirus Health Plan Elite (PPO) covers primary care and opioid treatment with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Physical, occupational, and speech therapies have a $40 copay and no coinsurance, and telehealth is available with a $0 to $50 copay and 20% coinsurance. Podiatry is not covered, and while some chiropractic, psychiatric, and mental health services are covered, routine chiropractic care alongside individual and group sessions are not covered.
Preventive Services See details
Preventive Services are partially covered by Aspirus Health Plan Elite (PPO) with no copay and no coinsurance for covered services, including annual physical exams, kidney disease education, and select screenings. While memory fitness, remote access technologies, and smoking cessation counseling are included, several supplemental benefits like health education, personal emergency response systems, and weight management are not covered.
Hearing Services See details
Hearing services are partially covered by the Aspirus Health Plan Elite (PPO), which features a $40 copay and no coinsurance for routine hearing exams, and a $599 to $899 copay with no coinsurance for up to two prescription hearing aids per year. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by the Aspirus Health Plan Elite (PPO), which offers one routine eye exam per year with a $0 to $40 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, including lenses, frames, and contact lenses, has no copay and no coinsurance up to a combined maximum benefit of $175 every year.
Dental Services See details
Dental services are partially covered by the Aspirus Health Plan Elite (PPO), featuring no copay and no coinsurance for covered care such as exams, cleanings, X-rays, and implants. Some exclusions apply, as other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aspirus Health Plan Elite (PPO) with no copay, though Medicare Part B chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance and no copay. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aspirus Health Plan Elite (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Aspirus Health Plan Elite (PPO) with no copay and a 20% coinsurance for durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. While diabetic supplies and services are limited to specified manufacturers, there are no preferred vendor restrictions for DME.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services under the Aspirus Health Plan Elite (PPO) are partially covered, as diagnostic procedures, tests, and lab services are not covered. Covered diagnostic services have no copay and no coinsurance, while radiological services require a $30 copay plus coinsurance for X-rays, a 20% coinsurance with no copay for therapeutic radiology, and a copay with no coinsurance for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the Aspirus Health Plan Elite (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Aspirus Health Plan Elite (PPO) with no coinsurance, though a copay applies to covered services. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Aspirus Health Plan Elite (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and days 44 to 100, and a $218 daily copay for days 21 to 43. The plan does not require a prior three-day inpatient hospital stay, though additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Aspirus Health Plan Elite (PPO) partially covers Other Services, providing Over-the-Counter (OTC) items and a Strong & Stable Kit with no copay and no coinsurance, which includes a $75 allowance every six months for OTC purchases. Acupuncture and meal benefits are not covered under this plan.
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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.
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