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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 2025, 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 2025.
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 $43.50. 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 $590.00 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 $9350.00 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) plan has a $590.00 deductible for prescription drugs. After the deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2000.00. This plan's premium may be reduced if you qualify for the low-income subsidy, also known as LIS or "Extra help". If you qualify for LIS, your monthly premium for Part D will be $43.50.
Additional Benefits
The Cooperative Advantage (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, including outpatient services, primary care, emergency services, vision, dental, and medical equipment, have a 20% coinsurance. Home health services have no copay. The plan also provides coverage for hearing exams, prescription hearing aids, and home infusion services, among other services. Additional benefits include coverage for ambulance services, with a 20% coinsurance, and transportation to health-related locations, with up to 40 one-way trips per year. The plan also offers an OTC benefit of $70.00 per month and a meal benefit for chronic illnesses. Some services, such as cardiac rehabilitation, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered. Prior authorization is required for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and outpatient substance abuse services are covered under the Cooperative Advantage (HMO D-SNP) plan, with a 20% coinsurance. Outpatient blood services are also covered with a 20% coinsurance, and the plan waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cooperative Advantage (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Cooperative Advantage (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to any health-related location are not covered. Transportation services to a plan-approved health-related location are covered for up to 40 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Cooperative Advantage (HMO D-SNP) plan. Emergency and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance. Occupational Therapy Services, Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Podiatry Services are not covered.
Preventive Services See details
The Cooperative Advantage (HMO D-SNP) plan covers preventive services, but does not cover annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
The Cooperative Advantage (HMO D-SNP) plan covers hearing exams with at most 20% coinsurance, with one routine hearing exam covered every year. Prescription hearing aids are covered up to a maximum of $2000 every three years, but fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
The Cooperative Advantage (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance, and eyewear with a 20% coinsurance up to a combined maximum of $500 per year for contact lenses and eyeglasses. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Cooperative Advantage (HMO D-SNP) plan covers Dental Services, with a 20% coinsurance for Medicare Dental Services, and other services including oral exams, dental x-rays, and cleanings. The plan also covers orthodontic services with a maximum benefit of $1,000 per year, and other services including restorative services and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. You will pay a $35 copay for Medicare Part B Insulin Drugs, with coinsurance ranging from 0% to 20% for all covered services.
Dialysis Services See details
Dialysis Services are covered under the Cooperative Advantage (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Cooperative Advantage (HMO D-SNP) plan covers Durable Medical Equipment (DME) with a 20% coinsurance, and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Equipment is covered with a 20% coinsurance for Medicare-covered diabetic supplies and therapeutic shoes/inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Cooperative Advantage (HMO D-SNP) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a coinsurance of at most 20% and no copay, while lab services are not covered. Therapeutic radiological services, diagnostic radiological services, and outpatient X-ray services are covered with a coinsurance of at most 20% and no copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Cooperative Advantage (HMO D-SNP) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. The plan requires prior authorization, and the coinsurance is determined by Medicare.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items, with a maximum benefit of $70.00 per month, and a Meal Benefit for chronic illnesses. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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