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2023 Network PlatinumPlus (PPO)

Network PlatinumPlus (PPO) H5215-001 is a 2023 Medicare Advantage Plan or Part-C by Network Health Medicare Advantage Plans available to residents in Wisconsin. This plan does not provide extra prescription drug (Part-D) coverage. Network Health Medicare Advantage Plans Network PlatinumPlus (PPO) has a monthly premium of $51.00 and has an in-network maximum out-of-pocket limit of $3,400 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $3,400 out-of-pocket. This can be an extremely nice safety net.

Network Health Medicare Advantage Plans works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Network PlatinumPlus (PPO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Network Health Medicare Advantage Plans and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Network Health Medicare Advantage Plans except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Wisconsin.



2023 Network Health Medicare Advantage Plans Medicare Advantage Plan Overview

Name:Network PlatinumPlus (PPO)
Plan ID:H5215 001 0
Provider:Network Health Medicare Advantage Plans
Year:2023
Type:Local PPO *
Combined Premium (C+D):$51.00/mo
MOOP:$3,400/yr
Similar Plan: H5215-002




What type of plan is Network PlatinumPlus (PPO)

Network PlatinumPlus (PPO) is a Local PPO *. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network, but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

How much does Network PlatinumPlus (PPO) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Network Health Medicare Advantage Plans charges a $51.00 premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Network PlatinumPlus (PPO) by Network Health Medicare Advantage Plans MOOP is $3,400. Once you spend $3,400 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.





2023 Summary of Benefits


The benefit information provided is a summary of what Network PlatinumPlus (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Network Health Medicare Advantage Plans helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)Covered


Contact lenses


VisionNot covered


Eyeglass frames


VisionNot covered


Eyeglass lenses


VisionNot covered


Eyeglasses (frames and lenses)


VisionNot covered


Other


VisionNot covered


Routine eye exam


In-Network Vision$10 copay
Out-of-Network Vision$0 copay


Upgrades


VisionNot covered



TransportationNot covered
In-Network Skilled Nursing Facility$20 per day for days 1 through 20
$196 per day for days 21 through 40
$0 per day for days 41 through 100
Out-of-Network Skilled Nursing Facility$20 per day for days 1 through 20
$196 per day for days 21 through 40
$0 per day for days 41 through 100


Occupational therapy visit


Out-of-Network Rehabilitation services$40 copay
In-Network Rehabilitation services$40 copay


Physical therapy and speech and language therapy visit


In-Network Rehabilitation services$40 copay
Out-of-Network Rehabilitation services$40 copay


Cleaning


Preventive dentalCovered under office visit


Dental x-ray(s)


Preventive dentalNot covered


Fluoride treatment


Preventive dentalNot covered


Office visit


Out-of-Network Preventive dental$0 copay
In-Network Preventive dental$30.00


Oral exam


Preventive dentalCovered under office visit



In-Network Preventive care$0 copay
Out-of-Network Preventive care$0 copay
In-Network Outpatient hospital coverage$350 copay per visit
Out-of-Network Outpatient hospital coverage$350 copay per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsYes


Inpatient hospital - psychiatric


In-Network Mental health services$150 per day for days 1 through 10
$0 per day for days 11 through 90
Out-of-Network Mental health services$150 per day for days 1 through 10
$0 per day for days 11 through 190


Outpatient group therapy visit


In-Network Mental health services$35 copay
Out-of-Network Mental health services$35 copay


Outpatient group therapy visit with a psychiatrist


In-Network Mental health services$35 copay
Out-of-Network Mental health services$35 copay


Outpatient individual therapy visit


Out-of-Network Mental health services$35 copay
In-Network Mental health services$35 copay


Outpatient individual therapy visit with a psychiatrist


In-Network Mental health services$35 copay
Out-of-Network Mental health services$35 copay


Chemotherapy


In-Network Medicare Part B drugs20% coinsurance
Out-of-Network Medicare Part B drugs20% coinsurance


Other Part B drugs


Out-of-Network Medicare Part B drugs20% coinsurance
In-Network Medicare Part B drugs20% coinsurance


Diabetes supplies


Out-of-Network Medical equipment/supplies$0-10 copay per item
In-Network Medical equipment/supplies$0 copay


Durable medical equipment (e.g., wheelchairs, oxygen)


Out-of-Network Medical equipment/supplies20% coinsurance per item
In-Network Medical equipment/supplies20% coinsurance per item


Prosthetics (e.g., braces, artificial limbs)


Out-of-Network Medical equipment/supplies20% coinsurance per item
In-Network Medical equipment/supplies20% coinsurance per item



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$3,400 In and Out-of-network
$3,400 In-network
In-Network Inpatient hospital coverage$175 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network Inpatient hospital coverage$175 per day for days 1 through 5
$0 per day for days 6 and beyond


Fitting/evaluation


In-Network Hearing$0 copay
Out-of-Network Hearing$40 copay


Hearing aids


Out-of-Network Hearing$495-1,695 copay
In-Network Hearing$495-1,695 copay


Hearing exam


In-Network Hearing$25 copay
Out-of-Network Hearing$25 copay



Health plan deductible$0
Out-of-Network Ground ambulance$250 copay
In-Network Ground ambulance$250 copay


Foot exams and treatment


In-Network Foot care (podiatry services)$40 copay
Out-of-Network Foot care (podiatry services)$40 copay


Routine foot care


Foot care (podiatry services)Not covered


Emergency


Emergency care/Urgent care$110 copay per visit (always covered)


Urgent care


Emergency care/Urgent care$40 copay per visit (always covered)


Primary


Out-of-Network Doctor visits$15 copay per visit
In-Network Doctor visits$15 copay per visit


Specialist


In-Network Doctor visits$40 copay per visit
Out-of-Network Doctor visits$40 copay per visit


Diagnostic radiology services (e.g., MRI)


In-Network Diagnostic procedures/lab services/imaging$25-100 copay
Out-of-Network Diagnostic procedures/lab services/imaging$25-100 copay


Diagnostic tests and procedures


In-Network Diagnostic procedures/lab services/imaging$5-25 copay
Out-of-Network Diagnostic procedures/lab services/imaging$5-25 copay


Lab services


In-Network Diagnostic procedures/lab services/imaging$0-5 copay
Out-of-Network Diagnostic procedures/lab services/imaging$0-10 copay


Outpatient x-rays


In-Network Diagnostic procedures/lab services/imaging$25 copay
Out-of-Network Diagnostic procedures/lab services/imaging$25 copay


Diagnostic services


Comprehensive dentalNot covered


Endodontics


Comprehensive dentalNot covered


Extractions


Comprehensive dentalNot covered


Non-routine services


Comprehensive dentalNot covered


Periodontics


Comprehensive dentalNot covered


Prosthodontics, other oral/maxillofacial surgery, other services


Comprehensive dentalNot covered


Restorative services


Comprehensive dentalNot covered



In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No




Network PlatinumPlus (PPO) Reviews


Is Network PlatinumPlus (PPO) a good plan? Network PlatinumPlus (PPO) received a 5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare Network PlatinumPlus Reviews among several different plans.

2022 Overall Rating
Part C Summary Rating
Part-D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with H5215-001 Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for Network Health Medicare Advantage Plans

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Network PlatinumPlus (PPO) requires you to live in that plan’s service area. The service area is listed below:

State: Wisconsin Medicare
County:Brown County MA Plans

Calumet County MA Plans

Dodge County MA Plans

Fond du Lac County MA Plans

Green Lake County MA Plans

Kewaunee County MA Plans

Manitowoc County MA Plans

Marquette County MA Plans

Oconto County MA Plans

Outagamie County MA Plans

Portage County MA Plans

Shawano County MA Plans

Sheboygan County MA Plans

Waupaca County MA Plans

Waushara County MA Plans

Winnebago County MA Plans



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How much does Network PlatinumPlus (PPO) cost?

Network Health Medicare Advantage Plans charges a $51.00 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Network PlatinumPlus (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Network PlatinumPlus (PPO) by Network Health Medicare Advantage Plans MOOP is $3,400. Once you spend $3,400 you will pay nothing for Part A or Part B covered services.

What type of plan is Network PlatinumPlus (PPO)?

Network PlatinumPlus (PPO) is a Local PPO *. A (PPO) is a Medicare plan that has contracts with a network of preferred providers. You do not need to select a primary care physician and you do not need referrals to see other providers in the network.

Is Network PlatinumPlus (PPO) a good plan?

Network PlatinumPlus (PPO) received a 5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

      Site Search:

MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.

Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

Every year, Medicare evaluates plans based on a 5-star rating system.