A non-government entity
Quartz Medicare Advantage (HMO)
Plan ID: H5262-5-0
Plan Summary PageGundersen Quartz Med Advantage Elite (HMO)
2027 Gundersen Quartz Med Advantage Elite (HMO) H5262 — 005 — 0 is a Medicare Advantage plan . It has received a 4-out-of-5 star rating from CMS for 2027.
Learn more about Gundersen Quartz Med Advantage Elite (HMO) H5262 - 005 - 0, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.
4 / 5 stars for 2027
$0.00 /mo
Monthly premium
$4000.00
Out-of-pocket maximum (In-Network)
Enroll online
Call to enroll
OR
Get personalized help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Plan Overview
2027 Gundersen Quartz Med Advantage Elite (HMO) H5262 — 005 — 0 is a HMO offered in Western Wisconsin and Northeast Iowa by Quartz Health Plan Corporation. It has a monthly premium of $124.00.
Premium Breakdown
Monthly plan premium
$124.00
Standard Part B premium (estimated)
$209.50
Note:
CMS has not yet announced the official 2027 standard Medicare Part B premium. The estimated 2027 premium is $209.50, per the 2026 Medicare Trustees Report; we'll update this page when CMS publishes the final amount. Your actual Part B premium may differ based on income (IRMAA), late enrollment penalties, Medicaid assistance, disability status, or other factors. Most people enrolled in Medicare Part B are required to pay this premium.
Special needs plan type
No
Out-of-pocket maximum (In-Network)
$4000.00
Plan Organization:
Quartz Health Plan Corporation
Parent Company:
University of Wisconsin Hospitals and Clincs Autho
Plan Type:
HMO
Location:
Western Wisconsin and Northeast Iowa
Drugs Covered:
No
Drug Formulary:
Pharmacies:
Doctors Link:
Deductibles
The amount you must pay each year before your plan starts to pay for covered services.
Sign up for Gundersen Quartz Med Advantage Elite (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Drug Coverage
Gundersen Quartz Med Advantage Elite (HMO) does not provide drug coverage. If drug coverage is something you need, you should consider shopping for other plans that do provide cost sharing on drugs.
Additional Benefits
Gundersen Quartz Med Advantage Elite (HMO) also provides the following benefits.
Inpatient Hospital
Inpatient Hospital benefits are covered.
Inpatient Hospital-Acute
Inpatient Hospital-Acute benefits are covered.
Cost Sharing:
More Details:
Copayment for Medicare-covered stay
300.00
Additional Days for Inpatient Hospital-Acute
Not covered.
Non-Medicare-covered Stay for Inpatient Hospital-Acute
Not covered.
Upgrades for Inpatient Hospital-Acute
Not covered.
Inpatient Hospital Psychiatric
Inpatient Hospital Psychiatric benefits are covered.
More Details:
Copayment for Medicare-covered stay
300.00
Additional Days for Inpatient Hospital Psychiatric
Not covered.
Non-Medicare-covered Stay for Inpatient Hospital Psychiatric
Not covered.
Outpatient Services
Outpatient Services benefits are covered.
All Outpatient Hospital Services
All Outpatient Hospital Services benefits are covered.
Outpatient Hospital Services
Outpatient Hospital Services benefits are covered.
Cost Sharing:
Observation Services
Not covered.
Ambulatory Surgical Center (ASC) Services
Ambulatory Surgical Center (ASC) Services benefits are covered.
Cost Sharing:
Outpatient Substance Abuse Services
Not covered.
Individual Sessions for Outpatient Substance Abuse
Individual Sessions for Outpatient Substance Abuse benefits are covered.
More Details:
Minimum copayment
35.00
Maximum copayment
35.00
Group Sessions for Outpatient Substance Abuse
Group Sessions for Outpatient Substance Abuse benefits are covered.
More Details:
Minimum copayment
35.00
Maximum copayment
35.00
Outpatient Blood Services
Not covered.
Partial Hospitalization
Partial Hospitalization benefits are covered.
Partial Hospitalization
Not covered.
Partial Hospitalization
Not covered.
Ambulance and Transportation Services
Ambulance and Transportation Services benefits are covered.
All Ambulance Services
All Ambulance Services benefits are covered.
Ground Ambulance Services
Ground Ambulance Services benefits are covered.
Cost Sharing:
Air Ambulance Services
Air Ambulance Services benefits are covered.
Cost Sharing:
Transportation Services
Not covered.
Transportation Services - Plan Approved Health-related Location
Not covered.
Transportation Services - Any Health-related Location
Not covered.
Emergency Services
Emergency Services benefits are covered.
Emergency Services
Emergency Services benefits are covered.
Cost Sharing:
More Details:
Enter number of days or hours
3
Urgently Needed Services
Urgently Needed Services benefits are covered.
Cost Sharing:
Worldwide Emergency Services
Worldwide Emergency Services benefits are covered.
More Details:
Maximum amount
20000.00
Worldwide Emergency Coverage
Worldwide Emergency Coverage benefits are covered.
Cost Sharing:
Worldwide Urgent Coverage
Worldwide Urgent Coverage benefits are covered.
Cost Sharing:
Worldwide Emergency Transportation
Worldwide Emergency Transportation benefits are covered.
Cost Sharing:
Primary Care
Primary Care benefits are covered.
Primary Care Physician Services
Primary Care Physician Services benefits are covered.
Cost Sharing:
Chiropractic Services
Chiropractic Services benefits are covered.
Cost Sharing:
Routine Chiropractic Care
Routine Chiropractic Care benefits are covered.
Cost Sharing:
Other Chiropractic Services
Other Chiropractic Services benefits are covered.
Cost Sharing:
More Details:
Service Name
X-rays, labs
Occupational Therapy Services
Occupational Therapy Services benefits are covered.
Cost Sharing:
Physician Specialist Services
Physician Specialist Services benefits are covered.
Cost Sharing:
Mental Health Specialty Services
Not covered.
Individual Sessions for Mental Health Specialty Services
Individual Sessions for Mental Health Specialty Services benefits are covered.
More Details:
Minimum copayment
35.00
Maximum copayment
35.00
Group Sessions for Mental Health Specialty Services
Group Sessions for Mental Health Specialty Services benefits are covered.
More Details:
Minimum copayment
35.00
Maximum copayment
35.00
Podiatry Services
Podiatry Services benefits are covered.
More Details:
Enhanced benefits (7f)
Routine Foot Care
Visits
6
Minimum copayment
45.00
Maximum copayment
45.00
Minimum copayment
45.00
Maximum copayment
45.00
Other Health Care Professional
Other Health Care Professional benefits are covered.
More Details:
Minimum copayment
10.00
Maximum copayment
45.00
Psychiatric Services
Not covered.
Individual Sessions for Psychiatric Services
Individual Sessions for Psychiatric Services benefits are covered.
More Details:
Minimum copayment
35.00
Maximum copayment
35.00
Group Sessions for Psychiatric Services
Group Sessions for Psychiatric Services benefits are covered.
More Details:
Minimum copayment
35.00
Maximum copayment
35.00
Physical Therapy and Speech-Language Pathology Services
Physical Therapy and Speech-Language Pathology Services benefits are covered.
Cost Sharing:
Additional Telehealth Benefits
Additional Telehealth Benefits benefits are covered.
Cost Sharing:
Opioid Treatment Program Services
Not covered.
Preventive Services
Preventive Services benefits are covered.
Medicare-covered Zero Dollar Preventive Services
Medicare-covered Zero Dollar Preventive Services benefits are covered.
Annual Physical Exam
Not covered.
Additional Preventive Services
Not covered.
Health Education
Not covered.
In-Home Safety Assessment
Not covered.
Personal Emergency Response System (PERS)
Not covered.
Medical Nutrition Therapy (MNT)
Medical Nutrition Therapy (MNT) benefits are covered.
More Details:
Numerical limit
1
Limit for additional sessions
2
Post discharge In-Home Medication Reconciliation
Not covered.
Re-admission Prevention
Not covered.
Wigs for Hair Loss Related to Chemotherapy
Not covered.
Weight Management Programs
Not covered.
Alternative Therapies
Not covered.
Therapeutic Massage
Therapeutic Massage benefits are covered.
More Details:
Number of sessions
12
Adult Day Health Services
Not covered.
Nutritional/Dietary Benefit
Not covered.
Home-Based Palliative Care
Not covered.
In-Home Support Services
Not covered.
Support for Caregivers of Enrollees
Not covered.
Additional Sessions of Smoking and Tobacco Cessation Counseling
Not covered.
Fitness Benefit
Not covered.
Enhanced Disease Management
Not covered.
Telemonitoring Services
Not covered.
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)
Not covered.
Home and Bathroom Safety Devices and Modifications
Not covered.
Counseling Services
Counseling Services benefits are covered.
More Details:
Session duration (in minutes)
50
Kidney Disease Education Services
Not covered.
Other Preventive Services
Other Preventive Services benefits are covered.
Glaucoma Screening
Not covered.
Diabetes Self-Management Training
Not covered.
Digital Rectal Exams
Not covered.
EKG following Welcome Visit
Not covered.
Hearing Services
Hearing Services benefits are covered.
Hearing Exams
Hearing Exams benefits are covered.
Cost Sharing:
Routine Hearing Exams
Routine Hearing Exams benefits are covered.
More Details:
Number of visits
1
Minimum copayment
25.00
Maximum copayment
25.00
Fitting/Evaluation for Hearing Aid
Not covered.
Prescription Hearing Aids
Prescription Hearing Aids benefits are covered.
More Details:
Maximum amount
1500.00
Prescription Hearing Aids (all types)
Prescription Hearing Aids (all types) benefits are covered.
More Details:
Quantity for Hearing Aids
2
Prescription Hearing Aids - Inner Ear
Not covered.
Prescription Hearing Aids - Outer Ear
Not covered.
Prescription Hearing Aids - Over the Ear
Not covered.
OTC Hearing Aids
Not covered.
Vision Services
Vision Services benefits are covered.
Eye Exams
Eye Exams benefits are covered.
Cost Sharing:
Routine Eye Exams
Routine Eye Exams benefits are covered.
More Details:
Number of visits
1
Other Eye Exam Services
Other Eye Exam Services benefits are covered.
More Details:
Number of visits
1
Service Name
Refraction
Eyewear
Eyewear benefits are covered.
More Details:
Combined maximum amount
300.00
Contact Lenses
Not covered.
Eyeglasses (lenses and frames)
Not covered.
Eyeglass lenses
Not covered.
Eyeglass frames
Not covered.
Upgrades
Not covered.
Dental Services
Dental Services benefits are covered.
Medicare Dental Services
Medicare Dental Services benefits are covered.
Cost Sharing:
Other Dental Services
Other Dental Services benefits are covered.
More Details:
Maximum amount
1000.00
Oral Exams
Not covered.
Dental X-Rays
Not covered.
Prophylaxis (Cleaning)
Not covered.
Fluoride Treatment
Not covered.
Orthodontic Services
Not covered.
Restorative Services
Not covered.
Adjunctive General Services
Not covered.
Endodontics
Not covered.
Periodontics
Not covered.
Prosthodontics, removable
Prosthodontics, removable benefits are covered.
Cost Sharing:
More Details:
Coinsurance percentage
50
Maxillofacial Prosthetics
Not covered.
Implant Services
Implant Services benefits are covered.
Cost Sharing:
More Details:
Coinsurance percentage
50
Prosthodontics, fixed
Prosthodontics, fixed benefits are covered.
Cost Sharing:
More Details:
Coinsurance percentage
50
Oral and Maxillofacial Surgery
Not covered.
Orthodontics
Not covered.
Home Infusion bundled Services
Not covered.
Dialysis Services
Dialysis Services benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Medical Equipment
Medical Equipment benefits are covered.
Durable Medical Equipment (DME)
Durable Medical Equipment (DME) benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Prosthetics/Medical Supplies - Non-Medicare benefit
Not covered.
Prosthetic Devices
Prosthetic Devices benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Medical Supplies
Medical Supplies benefits are covered.
Cost Sharing:
Diabetic Equipment
Not covered.
Diabetic Supplies
Not covered.
Diabetic Therapeutic Shoes/Inserts
Diabetic Therapeutic Shoes/Inserts benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Diabetic Equipment
Diabetic Equipment benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
10
Diagnostic and Radiological Services
Diagnostic and Radiological Services benefits are covered.
All Diagnostic services
Not covered.
Diagnostic Procedures/Tests
Diagnostic Procedures/Tests benefits are covered.
More Details:
Minimum copayment
10.00
Maximum copayment
10.00
Lab Services
Lab Services benefits are covered.
Cost Sharing:
All Radiological Services
Not covered.
Diagnostic Radiological Services
Diagnostic Radiological Services benefits are covered.
Cost Sharing:
More Details:
Minimum copayment
100.00
Therapeutic Radiological Services
Therapeutic Radiological Services benefits are covered.
Cost Sharing:
More Details:
Minimum copayment
45.00
Outpatient X-Ray Services
Outpatient X-Ray Services benefits are covered.
Cost Sharing:
Home Health Services
Not covered.
Cardiac Rehabilitation Services
Not covered.
Skilled Nursing Facility (SNF)
Skilled Nursing Facility (SNF) benefits are covered.
| Days 1-20: | Days 21-100: | |
|---|---|---|
| Copayment | 0.00 | 221.00 |
Additional Days beyond Medicare-covered for Skilled Nursing Facility (SNF)
Not covered.
Other Services
Other Services benefits are covered.
Acupuncture
Not covered.
Over-the-Counter (OTC) Items
Not covered.
Meal Benefit
Not covered.
Dual Eligible SNPs with Highly Integrated Services
Not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
SMID: MULTIPLAN_HCIHNMEDADVRX27_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
© 2026 Dog Media Solutions LLC. All rights reserved