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Gundersen MN Quartz Med Advantage Core 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 Core 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 Core D (w/Rx) (HMO) in 2026, please refer to our full plan details page.
Gundersen MN Quartz Med Advantage Core 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 Core 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 Core 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 Core D (w/Rx) (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. 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 $270.00 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 $5900.00 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 Core D (w/Rx) (HMO) plan features a $270 annual drug deductible. Under this plan, you will pay no copay for Tier 6 Select Care Drugs through standard pharmacies and standard mail order. For Tier 1 Preferred Generic drugs, standard copays start at $2 for a one-month supply, while Tier 2 Generic drugs require a $10 copay for a one-month supply. For higher-tier medications, costs are determined by coinsurance percentages rather than flat copays. Tier 3 Preferred Brand drugs require a 20% coinsurance and Tier 4 Non-Preferred drugs carry a 40% coinsurance. Tier 5 Specialty drugs require a 30% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) plan offers robust coverage with predictable copays and no coinsurance for many key medical services. Members pay a $25 copay for primary care visits, a $60 copay for specialists, and no copay for standard preventive services. For hospital care, inpatient stays require a $270 daily copay for the first six days and no copay thereafter, while emergency room visits carry a $130 copay. Essential supplemental benefits like routine vision and hearing exams are available with a $40 copay, alongside helpful allowances for eyewear and prescription hearing aids. Preventive dental care features no copay up to a $400 annual limit, though advanced dental procedures require a 50% coinsurance. Other specialized needs, including dialysis and durable medical equipment, are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $270 daily copay for days 1 through 6 and no copay for days 7 and beyond. Prior authorization is required, and non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay ranging from $0 to $350 with prior authorization required, while outpatient substance abuse individual and group sessions have a $50 copay.
Partial Hospitalization See details
The Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) covers partial hospitalization services with no coinsurance and either no copay or a $55 copay. Prior authorization is required for the services that charge a copay.
Ambulance and Transportation Services See details
Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance, subject to prior authorization. Although some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 3 days, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $20,000 maximum with no coinsurance and copays of $130, $50, and $300 respectively.
Primary Care See details
Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) covers primary care physician visits for a $25 copay and specialist visits for a $60 copay, both with no coinsurance. Other covered services, including physical therapy, chiropractic care, and mental health sessions, require copays ranging from $15 to $60 with no coinsurance, while opioid treatment services are available with no copay and no coinsurance.
Preventive Services See details
Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) covers preventive services with no copay and no coinsurance for annual physicals, kidney disease education, and other standard screenings. This benefit is partially covered, as therapeutic massage requires a $25 copay with no coinsurance, and several services such as fitness benefits, weight management, and health education are not covered.
Hearing Services See details
Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) offers hearing services with a $40 copay and no coinsurance for annual routine hearing exams, and no copay or coinsurance for prescription hearing aids up to an $800 maximum every two years. However, this benefit is only partially covered as fitting and evaluation, 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 covered by Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO), featuring annual routine eye exams and refractions for a $40 copay and no coinsurance. Eyewear is also covered with no copay, no coinsurance, and no deductible, offering up to a $150 annual maximum benefit for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) partially covers dental services, with Medicare-covered dental requiring a $60 copay and no coinsurance. Most preventive and comprehensive services have no copay and no coinsurance up to a $400 annual maximum, though prosthodontics and implants carry 50% coinsurance and no copay. Other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Medicare Part B chemotherapy and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) partially covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and diabetic therapeutic shoes. Prior authorization is required for most covered equipment, and diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required for diagnostic services. Members will pay a $20 copay for lab services, diagnostic procedures, and outpatient X-rays, a $75 minimum copay for therapeutic radiological services, and a $185 minimum copay for diagnostic radiological services.
Home Health Services See details
Home Health Services are covered under the Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) with no coinsurance for all services. Covered benefits include unlimited cardiac and intensive cardiac rehabilitation for a $30 copay, pulmonary rehabilitation for a $15 copay, and Supervised Exercise Therapy (SET) for PAD services for a $25 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) with no coinsurance and no prior three-day hospital stay requirement. There is no copay for days 1 through 20 and a $215 daily copay for days 21 through 100, though prior authorization is required and 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 Core D (w/Rx) (HMO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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