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Gundersen MN Quartz Med Advantage Basic 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 Basic 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 Basic D (w/Rx) (HMO) in 2026, please refer to our full plan details page.
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) is a HMO plan offered by University of Wisconsin Hospitals and Clincs Autho available for enrollment in 2026 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 Basic 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 Basic 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 Basic 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 $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 $6700.00 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 Basic D (w/Rx) (HMO) plan features an annual drug deductible of $270. For Tier 6 select care drugs, you will pay no copay for one-, two-, or three-month supplies at standard pharmacies and through mail order. Tier 1 preferred generics and Tier 2 generics are also highly affordable, requiring standard copays starting at $2.00 and $10.00 respectively for a one-month supply. Brand-name and specialty medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 40% coinsurance. Tier 5 specialty drugs are covered at standard pharmacies with a 30% coinsurance for a one-month supply.
Additional Benefits
The Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) plan offers comprehensive coverage with predictable cost-sharing, featuring no coinsurance for many core services. Members pay no copay for preventive care, annual physicals, and home health services, while primary care visits require a $30 copay and specialist visits carry a $75 copay. Emergency care is covered with a $130 copay, and inpatient hospital stays require a $300 daily copay for the first seven days, followed by no copay for additional days. Routine dental cleanings and exams are available with no copay, though Medicare-covered dental services and routine vision or hearing exams require copays ranging from $40 to $75. For medical equipment and dialysis services, members will pay a 20% coinsurance with no copay. Diagnostic services, such as lab tests and X-rays, are covered with a flat $50 copay and no coinsurance.
Inpatient Hospital See details
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $300 daily copay for days 1 through 7 and no copay for day 8 and beyond. Prior authorization is required for these services, and non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services which feature no copay. Outpatient hospital services have a copay ranging from $0.00 to $375.00 with prior authorization required, while outpatient substance abuse individual and group sessions require a $60.00 copay.
Partial Hospitalization See details
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) covers partial hospitalization services with no coinsurance and either no copay or a $100 copay. Prior authorization is required for the services that carry the $100 copay.
Ambulance and Transportation Services See details
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) covers ground and air ambulance services with a $350 copay and no coinsurance, though prior authorization is required. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) covers emergency services with a $130 copay (waived if admitted within three 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 plan benefit with copays of $130, $50, and $350, respectively, and no coinsurance.
Primary Care See details
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) covers primary care physician visits for a $30 copay and specialist visits for a $75 copay, both with no coinsurance. Other covered benefits like physical therapy, chiropractic care, and mental health services carry copays ranging from $15 to $75 with no coinsurance, while opioid treatment features no copay and no coinsurance.
Preventive Services See details
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) covers Medicare-covered preventive services, annual physical exams, and kidney disease education with no copay and no coinsurance. Additional preventive benefits are partially covered with no coinsurance—including counseling, medical nutrition therapy, and therapeutic massage for a $40 copay—but fitness benefits, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) partially covers hearing services, offering one routine hearing exam every year with a $40 copay and no coinsurance. Hearing aid fittings and evaluations, prescription hearing aids, and over-the-counter hearing aids are not covered under this plan.
Vision Services See details
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) covers annual routine eye and refraction exams with a $40 copay and no coinsurance. Covered eyewear, including eyeglasses and contact lenses, has no copay or coinsurance and is subject to a $75 annual maximum benefit.
Dental Services See details
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) partially covers dental services, offering Medicare-covered dental care for a $75 copay and no coinsurance. Covered preventive services, including one annual cleaning and one oral exam, require no copay and no coinsurance, while restorative, endodontic, periodontic, and orthodontic services are not covered.
Home Infusion bundled Services See details
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Under this plan, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while other Part B drugs, including chemotherapy and radiation drugs, carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) partially covers medical equipment with no copays and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies are not covered under this plan, and prior authorization is required for certain equipment.
Diagnostic and Radiological Services See details
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) covers diagnostic and radiological services with no coinsurance. Members pay a $50 copay for lab services, outpatient X-rays, and diagnostic tests, alongside a minimum copay of $85 for therapeutic radiological services and $300 for diagnostic radiological services.
Home Health Services See details
Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) with no coinsurance for unlimited visits. Members pay a $40 copay for cardiac and intensive cardiac therapy, a $35 copay for pulmonary rehabilitation, and a $25 copay for supervised exercise therapy (SET) for peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $215 copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other Services are covered under the Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) plan, meaning some services are covered but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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