A non-government entity
Cooperative Medicare Advantage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cooperative Medicare Advantage (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cooperative Medicare Advantage (HMO) in 2026, please refer to our full plan details page.
Cooperative Medicare Advantage (HMO) is a HMO plan offered by Group Health Cooperative of Eau Claire available for enrollment in 2026 to people living in Wisconsin. The overall rating for this plan is not yet available for 2026.
It's important to know that Cooperative Medicare Advantage (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 Cooperative Medicare Advantage (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 Cooperative Medicare Advantage (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 $275.00 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 $6000.00 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 Cooperative Medicare Advantage (HMO)
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 Cooperative Medicare Advantage (HMO) plan features an annual drug deductible of $275. For cost savings, Tier 1 preferred generic drugs have no copay for one, two, or three-month supplies at standard pharmacies and standard mail order. Tier 2 generic medications require a standard pharmacy copay of $15 for a one-month supply, $30 for a two-month supply, and $45 for a three-month supply. For brand-name and specialty medications, costs are structured around coinsurance. Tier 3 preferred brand drugs require 19% coinsurance, while Tier 4 non-preferred drugs carry a 50% coinsurance for standard pharmacy and mail order options. Tier 5 specialty drugs are subject to a 29% coinsurance for a one-month supply at a standard pharmacy.
Additional Benefits
The Cooperative Medicare Advantage (HMO) plan offers affordable healthcare coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For hospital stays, members pay a $295 daily copay for the first six days of inpatient care with no copay thereafter, while emergency room visits carry a $130 copay. Specialist visits, physical therapy, and mental health services are also highly accessible with a low $35 copay and no coinsurance. This plan also includes valuable everyday benefits, featuring no copay for routine dental care up to a $1,000 annual limit and no copay for prescription hearing aids up to a $2,000 allowance every three years. Vision exams and routine eye care are covered with a $35 copay, which includes up to a $500 annual allowance for contacts or eyeglasses. Additionally, members can take advantage of free transportation for up to 40 one-way trips per year and a $55 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Cooperative Medicare Advantage (HMO) with no coinsurance, requiring a $295 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional days are covered for acute care, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Cooperative Medicare Advantage (HMO) covers outpatient hospital and observation services with a $300 copay and no coinsurance, and ambulatory surgical center services with a $225 copay and no coinsurance. Outpatient substance abuse services require a $35 copay per session with no coinsurance, while outpatient blood services are available with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Cooperative Medicare Advantage (HMO) with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Cooperative Medicare Advantage (HMO) covers ground and air ambulance services with a $295 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 40 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Cooperative Medicare Advantage (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 3 days. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with no coinsurance and copays ranging from $50 to $295.
Primary Care See details
Cooperative Medicare Advantage (HMO) offers primary care physician services with no copay and no coinsurance, while specialist, therapy, and mental health services require a $35 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, excluding other chiropractic services.
Preventive Services See details
Preventive services are covered by Cooperative Medicare Advantage (HMO) with no copay and no coinsurance, including annual physical exams and kidney disease education. However, the benefit is only partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, bathroom safety, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Cooperative Medicare Advantage (HMO), featuring one annual routine exam with a $35 copay, no coinsurance, and no deductible, and prescription hearing aids with no copay and no coinsurance up to a $2,000 limit every three years. Fitting and evaluation exams, OTC hearing aids, and 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 Cooperative Medicare Advantage (HMO) plan, featuring a $35 copay and no coinsurance for annual routine eye exams and covered eyewear with no deductible. While contact lenses and eyeglasses (lenses and frames) are covered up to a $500 annual limit, other eye exam services, individual lenses, individual frames, and upgrades are not covered.
Dental Services See details
Cooperative Medicare Advantage (HMO) dental services are partially covered, featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for most preventive and comprehensive services 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
Home Infusion bundled Services are covered by the Cooperative Medicare Advantage (HMO) with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy, radiation, and other Part B drugs are covered with no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Cooperative Medicare Advantage (HMO) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Cooperative Medicare Advantage (HMO) covers medical equipment with no copays, requiring prior authorization and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic equipment is partially covered with no copay or coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Cooperative Medicare Advantage (HMO) covers diagnostic and radiological services with prior authorization required for all services. Diagnostic procedures, tests, and lab services require a $20 copay and no coinsurance, while radiological services feature a $50 copay for X-rays, a $150 minimum copay for diagnostic radiology, and a 20% minimum coinsurance for therapeutic radiology.
Home Health Services See details
Cooperative Medicare Advantage (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Cooperative Medicare Advantage (HMO) with no copay and no coinsurance, though only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Cooperative Medicare Advantage (HMO) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed for admission, and additional days beyond the standard 100 days are not covered.
Other Services See details
Cooperative Medicare Advantage (HMO) provides partial coverage for other services, featuring over-the-counter (OTC) items with no copay and no coinsurance up to a $55 limit every three months. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved