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Gundersen MN Quartz Med Advantage Elite (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gundersen MN Quartz Med Advantage Elite (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 Elite (HMO) in 2025, please refer to our full plan details page.
Gundersen MN Quartz Med Advantage Elite (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, Winona. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Gundersen MN Quartz Med Advantage Elite (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 Elite (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 Elite (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 $3000.00 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 Elite (HMO).
Additional Benefits
The Gundersen MN Quartz Med Advantage Elite (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a $300 copay and outpatient services with copays ranging from $0 to $150. It also covers a wide array of services such as primary care with a $5 copay, hearing and vision services, dental, and home health with no copay. This plan provides additional benefits such as ambulance services with a $275 copay, and emergency services with a $140 copay. It also includes coverage for home infusion, dialysis, and medical equipment with varying copays and coinsurance, as well as skilled nursing facility services with no copay for the first 20 days.
Inpatient Hospital See details
The Gundersen MN Quartz Med Advantage Elite (HMO) plan covers inpatient hospital services, including services not usually covered by Medicare plans, with a $300 copay per stay for Medicare-covered stays. Additional days for inpatient hospital are covered with no copay, while non-Medicare-covered stays and upgrades for inpatient hospital are not covered. Inpatient Hospital Psychiatric benefits are covered, but Non-Medicare-covered Stay for Inpatient Hospital Psychiatric is not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $150, observation services, and ambulatory surgical center (ASC) services with no copay. Outpatient substance abuse services, including both individual and group sessions, have a $35 copay, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Gundersen MN Quartz Med Advantage Elite (HMO) plan, with a $275 copay for both ground and air ambulance services and no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $140 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The Gundersen MN Quartz Med Advantage Elite (HMO) plan covers primary care physician services with a $5 copay, chiropractic services with a $10 copay, occupational therapy services with a $15 copay, physician specialist services with a $35 copay, and mental health specialty services with a $35 copay for individual and group sessions. The plan also covers podiatry services with a $35 copay, other health care professional services with a $10-$35 copay, psychiatric services with a $35 copay for individual and group sessions, physical therapy and speech-language pathology services with a $15 copay, and additional telehealth benefits with a $0-$35 copay.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and additional services are covered by the Gundersen MN Quartz Med Advantage Elite (HMO) plan. Some services are not covered, including Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Post discharge In-Home Medication Reconciliation, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, 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, Home and Bathroom Safety Devices and Modifications.
Hearing Services See details
Hearing Services includes routine hearing exams with a $15 copay, with a limit of one exam per year. Prescription hearing aids are covered with a maximum benefit of $1500 every two years, but fitting and evaluation for hearing aids, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $10 copay, and eyewear with a combined maximum of $250 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Gundersen MN Quartz Med Advantage Elite (HMO) plan covers dental services with a $30 copay for Medicare dental services. Other dental services are covered up to a maximum of $550 per year, and include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery, but does not cover maxillofacial prosthetics or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 15%.
Dialysis Services See details
Dialysis Services are covered under the Gundersen MN Quartz Med Advantage Elite (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, and requires prior authorization. Prosthetics and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have a 0-35% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a $4 copay, lab services with a $5 copay, diagnostic radiological services with a $60 copay, therapeutic radiological services with a $25 copay, and outpatient X-ray services with a $5 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Gundersen MN Quartz Med Advantage Elite (HMO) plan, with no copay or coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are covered. Each service has a copay of $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Gundersen MN Quartz Med Advantage Elite (HMO) plan. For days 1-20, there is no copay, while for days 21-100, the copay is $150.
Other Services See details
The Gundersen MN Quartz Med Advantage Elite (HMO) plan does not cover acupuncture, meal benefits, 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, or Self-Directed Personal Assistance Services. Over-the-counter (OTC) items are covered with a maximum benefit of $20.00 every three months.
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