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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 2025, 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, 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 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 $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 $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 $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 has a $225 deductible for prescription drugs. After the deductible, your cost will vary depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay a $15 copay at a standard or mail-order pharmacy. For specialty tier drugs, you will have no copay.
Additional Benefits
The Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services with varying copays. Emergency, primary care, and preventive services are also covered, with specific copays for each. The plan provides additional coverage for hearing, vision, and dental services, including hearing aids, eye exams, and dental care with annual maximums. Additional benefits include ambulance services, home health, cardiac rehabilitation, and skilled nursing facility care. There are also coverage options for home infusion, dialysis, and medical equipment, each with specific cost-sharing requirements. The plan offers some additional services such as over-the-counter items, but certain services like private duty nursing and personal care services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $270 for days 1-6 and no copay for days 7-90. Additional days for both Inpatient Hospital-Acute and Psychiatric are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $350, observation services, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a copay of $50 for individual and group sessions, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) plan. The plan covers ground and air ambulance services with a $350 copay, and no coinsurance; however, 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 $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $350 copay.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with a $25 copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $40 copay, Physician Specialist Services with a $55 copay, and Mental Health Specialty Services with a $50 copay for individual and group sessions. Also covered are Podiatry Services with a $55 copay, Other Health Care Professional services with a copay between $20 and $55, Psychiatric Services with a $50 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $40 copay, Additional Telehealth Benefits with a copay between $0 and $55, and Opioid Treatment Program Services.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, and additional preventive services. Additional preventive services include a copay for Therapeutic Massage, and may have a maximum plan benefit coverage amount for the Fitness Benefit. 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 include hearing exams and prescription hearing aids. Hearing exams have a $25 copay, and routine hearing exams are covered with a $10 copay for one exam every year. Prescription hearing aids are covered up to $1000 every two years.
Vision Services See details
Vision Services include coverage for eye exams with a $25 copay, and coverage for eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames; there is a combined maximum of $150 per year for eyewear. Routine eye exams and other eye exam services are covered once per year.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $50 copay, and other dental services with a $350 maximum benefit per year. The plan covers oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), implant services, prosthodontics (fixed), and oral and maxillofacial surgery. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have 0-35% coinsurance, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a $20 copay for Diagnostic Procedures/Tests and Lab Services, a maximum copay of $160 for Diagnostic Radiological Services, a maximum copay of $65 for Therapeutic Radiological Services, and a $20 copay for Outpatient X-Ray Services. Prior authorization is required.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, including services not usually covered by Medicare plans. Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, have a $30 copay; Pulmonary Rehabilitation Services have a $15 copay; and SET for PAD Services have a $25 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $178. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services for Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) includes OTC items with a maximum benefit of $15.00 every three months, as well as Acupuncture, Meal Benefit, 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, and Self-Directed Personal Assistance Services are not covered.
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