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Cooperative Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cooperative Advantage (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cooperative Advantage (HMO D-SNP) in 2026, please refer to our full plan details page.
Cooperative Advantage (HMO D-SNP) is a HMO D-SNP plan offered by Group Health Cooperative of Eau Claire available for enrollment in 2025 to people living in Wisconsin. The overall rating for this plan is not yet available for 2026.
It's important to know that Cooperative Advantage (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:
Cooperative Advantage (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 Cooperative Advantage (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 Cooperative Advantage (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.
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 $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 Cooperative Advantage (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. You must pay this deductible amount out-of-pocket for your covered medications before the plan starts to pay its share. Specific drug tier details, copayments, and coinsurance percentages are currently unavailable for this plan. To find out how your specific prescriptions are covered, it is best to verify your medications directly against the plan's formulary.
Additional Benefits
The Cooperative Advantage (HMO D-SNP) plan offers comprehensive healthcare coverage with no copays for the vast majority of services. Major benefits such as inpatient hospital care, skilled nursing stays, home health, and up to 40 one-way transportation trips per year are covered with no copay and no coinsurance. Members also enjoy valuable extras at no cost, including preventive dental services up to $1,000 annually and a $90 monthly allowance for over-the-counter items. Most other medical services, including doctor visits, outpatient care, emergency services, and durable medical equipment, require no copay and a 20% coinsurance. Routine vision and hearing benefits are also covered with no copay, featuring a $500 annual limit for eyewear and up to $2,000 every three years for prescription hearing aids. Many of these benefits require prior authorization, helping to coordinate your care while keeping your out-of-pocket expenses low.
Inpatient Hospital See details
Cooperative Advantage (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Cooperative Advantage (HMO D-SNP) covers outpatient services with no copays and a 20% coinsurance for outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for outpatient hospital and ambulatory surgical center services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by Cooperative Advantage (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Cooperative Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 40 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
Cooperative Advantage (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital within three days. For worldwide emergency services, some services are covered but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Cooperative Advantage (HMO D-SNP) covers primary care, specialist, mental health, therapy, and opioid treatment services with no copay and 20% coinsurance, with prior authorization required for physical, occupational, and speech therapies. Routine chiropractic care is also covered with 20% coinsurance, but other chiropractic services and podiatry services are not covered.
Preventive Services See details
Preventive Services under the Cooperative Advantage (HMO D-SNP) plan are partially covered, featuring no copay and no coinsurance for zero-dollar preventive services and memory fitness, while annual physical exams and most other supplemental benefits are not covered. Covered services such as kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs require no copay and a 20% coinsurance.
Hearing Services See details
Cooperative Advantage (HMO D-SNP) partially covers hearing services, offering one routine hearing exam annually with no copay and 20% coinsurance, though fitting evaluations and over-the-counter hearing aids are not covered. Prescription hearing aids are covered with no copay and no coinsurance up to a $2,000 maximum every three years, but inner ear, outer ear, and over-the-ear prescription types are excluded.
Vision Services See details
Vision services are partially covered by Cooperative Advantage (HMO D-SNP) with no deductible, no copays, and a 20% coinsurance for routine eye exams (limited to one yearly) and contact lenses. Covered eyewear has a $500 annual maximum for contact lenses and eyeglasses, while other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Cooperative Advantage (HMO D-SNP) offers partially covered dental services, including Medicare-covered dental with no copay and 20% coinsurance, alongside preventive and comprehensive services with no copay and no coinsurance up to a $1,000 annual limit. Other diagnostic dental services, other preventive dental services, and orthodontics are not covered.
Home Infusion bundled Services See details
Cooperative Advantage (HMO D-SNP) covers Home Infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance of 0% to 20%, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Cooperative Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Cooperative Advantage (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for these services, and preferred vendors may apply for durable medical equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Cooperative Advantage (HMO D-SNP), with lab services not covered and prior authorization required for all other services. Covered diagnostic procedures, radiological services, and outpatient X-rays have no copay and a 20% coinsurance.
Home Health Services See details
Cooperative Advantage (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services, including intensive cardiac, pulmonary, and SET for PAD services, are covered by Cooperative Advantage (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Cooperative Advantage (HMO D-SNP) covers skilled nursing facility (SNF) care with no copay and no coinsurance, requiring prior authorization but no prior three-day hospital stay. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Cooperative Advantage (HMO D-SNP) provides partially covered other services with no copay and no coinsurance, including a chronic illness meal benefit and up to $90 per month in reimbursed over-the-counter items. Acupuncture is not covered under this benefit.
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