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Gundersen MN Quartz Med Advantage Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gundersen MN Quartz Med Advantage Value (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 (HMO) in 2026, please refer to our full plan details page.
Gundersen MN Quartz Med Advantage Value (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 (HMO) 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 Gundersen MN Quartz Med Advantage Value (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 (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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Gundersen MN Quartz Med Advantage Value (HMO).
Additional Benefits
The Gundersen MN Quartz Med Advantage Value (HMO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no coinsurance for inpatient hospital stays, outpatient services, and emergency care. Primary care doctor visits require a low $15 copay, while specialist visits have a $50 copay, both with no coinsurance. For inpatient hospital stays, members pay a $225 daily copay for the first six days and no copay for subsequent days. This plan also provides valuable routine care benefits, including dental coverage up to a $1,000 annual limit with no copay for most preventive services. Additionally, members benefit from routine vision and hearing exams with a $35 copay, alongside allowances of up to $225 annually for eyewear and $1,500 every two years for hearing aids with no copay. Essential services like home health care and annual preventive physicals are fully covered with no copay or coinsurance.
Inpatient Hospital See details
Gundersen MN Quartz Med Advantage Value (HMO) partially covers inpatient acute and psychiatric hospital services with no coinsurance, though prior authorization is required. Patients pay a $225 daily copay for days 1 through 6 and no copay for days 7 and beyond (including unlimited additional days), while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Gundersen MN Quartz Med Advantage Value (HMO) covers outpatient services with no coinsurance, including no copays for ambulatory surgical center and blood services. Outpatient hospital services require prior authorization and carry a copay of $0 to $200, while outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
Gundersen MN Quartz Med Advantage Value (HMO) covers partial hospitalization services with no copay and no coinsurance. Prior authorization may be required for these covered services.
Ambulance and Transportation Services See details
Gundersen MN Quartz Med Advantage Value (HMO) covers ground and air ambulance services with a $300 copay per service and no coinsurance, with prior authorization required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Gundersen MN Quartz Med Advantage Value (HMO) covers emergency services 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 and no coinsurance, while worldwide emergency services are covered up to a $20,000 maximum benefit with no coinsurance and copays of $60 for urgent care, $150 for emergency care, and $300 for emergency transportation.
Primary Care See details
Gundersen MN Quartz Med Advantage Value (HMO) covers primary care physician visits with a $15 copay and specialist visits with a $50 copay, both with no coinsurance. Other covered services include physical, occupational, and speech therapy for a $30 copay, mental health and psychiatric services for a $40 copay, and opioid treatment with no copay, all featuring no coinsurance.
Preventive Services See details
Preventive services are partially covered under the Gundersen MN Quartz Med Advantage Value (HMO) plan, featuring no copay and no coinsurance for annual physical exams, kidney disease education, and standard screenings. Therapeutic massage is covered with a $15 copay and no coinsurance, but several services including fitness benefits, weight management, health education, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by the Gundersen MN Quartz Med Advantage Value (HMO) plan, which offers routine hearing exams for a $35 copay and no coinsurance, but excludes fitting and evaluation exams. Prescription hearing aids are covered up to a $1,500 limit every two years with no copay and no coinsurance, though OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription models, are not covered.
Vision Services See details
Gundersen MN Quartz Med Advantage Value (HMO) covers vision services with no deductibles, including annual routine eye exams and refractions for a $35 copay and no coinsurance. Eyewear, including contacts, lenses, frames, and upgrades, is covered with no copay and no coinsurance up to a $225 combined annual maximum.
Dental Services See details
Gundersen MN Quartz Med Advantage Value (HMO) offers partially covered dental services up to a $1,000 annual maximum, with Medicare-covered dental requiring a $50 copay and no coinsurance. Most preventive and comprehensive services feature no copay and no coinsurance, while implants and prosthodontics require 50% coinsurance and no copay; however, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Gundersen MN Quartz Med Advantage Value (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Gundersen MN Quartz Med Advantage Value (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Gundersen MN Quartz Med Advantage Value (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay, a 20% coinsurance, and prior authorization requirements. Diabetic equipment is partially covered with no copay and a 20% coinsurance for therapeutic shoes and inserts, though diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Gundersen MN Quartz Med Advantage Value (HMO) with no coinsurance, though prior authorization is required for diagnostic services. Members pay a $10 copay for lab services, diagnostic tests, and outpatient X-rays, 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 by the Gundersen MN Quartz Med Advantage Value (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Gundersen MN Quartz Med Advantage Value (HMO) covers unlimited cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services. These covered services require a $25 copay per session and have no coinsurance.
Skilled Nursing Facility (SNF) See details
Gundersen MN Quartz Med Advantage Value (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20 and a $215 daily copay for days 21 through 100, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Gundersen MN Quartz Med Advantage Value (HMO) indicates that other services are covered, but in practice only some services are covered as acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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