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Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gundersen MN Quartz Med Advantage Value 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 Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) in 2026, please refer to our full plan details page.
Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) is a HMO plan offered by University of Wisconsin Hospitals and Clincs Autho available for enrollment in 2025 to people living in Counties: Fillmore, Houston, Wabasha. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Gundersen MN Quartz Med Advantage Value 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 Gundersen MN Quartz Med Advantage Value 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 Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $72.00. 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 $225.00 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 $4200.00 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 Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) plan features an annual drug deductible of $225. For prescription coverage, Tier 6 select care drugs are highly affordable with no copay for standard retail or mail-order deliveries. Standard pharmacy and mail-order copays for Tier 1 preferred generics start at $2.00 for a one-month supply, while Tier 2 generics start at a $10.00 copay. Higher-tier medications transition to coinsurance, with Tier 3 preferred brands requiring 20% coinsurance and Tier 4 non-preferred drugs requiring 40% coinsurance. Tier 5 specialty drugs carry a 30% coinsurance for a one-month supply at standard pharmacies. Two-month and three-month supply options are also available for Tiers 1 through 4, providing predictable pricing for longer-term prescriptions.
Additional Benefits
The Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) plan offers comprehensive medical coverage featuring predictable copays and no coinsurance for many primary services. Members pay a $15 copay for primary care visits, a $50 copay for specialists, and no copay for annual preventive care. For hospital stays, there is a $250 daily copay for the first six days of inpatient care and no copay for subsequent days, while emergency room visits carry a $150 copay. This plan also includes essential dental, vision, and hearing benefits to help manage your out-of-pocket healthcare costs. Routine eye and hearing exams are available with a $35 copay, alongside coverage allowances for prescription eyewear and hearing aids. Additionally, most preventive dental services require no copay, while durable medical equipment and dialysis services are covered with a 20% coinsurance.
Inpatient Hospital See details
Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) partially covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $250 daily copay for days 1 through 6 and no copay for days 7 and beyond. Prior authorization is required for these services, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services covered by the Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) plan feature no coinsurance, with no copays for ambulatory surgical center and blood services. Outpatient hospital services require a $0 to $200 copay with prior authorization, while outpatient substance abuse individual and group sessions carry a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) with no copay and no coinsurance, although prior authorization may be required.
Ambulance and Transportation Services See details
Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) covers Medicare-approved ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services require a $60 copay with no coinsurance, while worldwide emergency services are covered up to a $20,000 lifetime maximum with no coinsurance and copays of $150 for emergency care, $60 for urgent care, and $300 for emergency transportation.
Primary Care See details
Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) covers primary care physician visits for a $15 copay and specialist visits for a $50 copay, both with no coinsurance. Other covered benefits, including physical therapy, mental health services, and podiatry, require copays ranging from $40 to $50 with no coinsurance, while opioid treatment services are available with no copay and no coinsurance.
Preventive Services See details
Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered with no coinsurance, offering medical nutrition therapy, counseling, and therapeutic massage for a $20 copay, while fitness benefits, health education, and weight management programs are not covered.
Hearing Services See details
Hearing services are partially covered by the Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) plan, featuring a $35 copay and no coinsurance for annual routine hearing exams, though fitting and evaluation services are not covered. Prescription hearing aids are covered with no copay and no coinsurance up to a $1,250 maximum every two years, but OTC devices and inner, outer, and over-the-ear prescription models are not covered.
Vision Services See details
Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) covers routine eye exams and refractions with a $35 copay, no coinsurance, and no deductible. Eyewear is also covered with no copay, no coinsurance, and no deductible, up to a combined maximum benefit of $225 per year.
Dental Services See details
Dental services are partially covered by the Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) plan, offering Medicare-covered dental with a $50 copay and no coinsurance, alongside a $500 annual limit for other dental services. Most preventive and restorative services have no copay and no coinsurance, while implants and prosthodontics require no copay and a 50% coinsurance. Other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs have a 0% to 20% coinsurance, while Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance.
Dialysis Services See details
Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic equipment is partially covered with no copay and 20% coinsurance for therapeutic shoes and inserts, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) with no coinsurance. Members pay a $15 copay for lab services, outpatient X-rays, and diagnostic procedures, a $60 copay for therapeutic radiological services, and a $100 copay for diagnostic radiological services.
Home Health Services See details
Home Health Services are covered under the Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) covers unlimited cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services. These covered benefits require a $25 copay per service and no coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) with no coinsurance and without requiring a 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 prior authorization is required, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other Services are not covered under the Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) plan, meaning acupuncture, over-the-counter (OTC) items, and meal benefits are excluded from coverage.
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