Network PlatinumPremier (PPO) H5215-006 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 PlatinumPremier (PPO) has a monthly premium of $177.00 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 PlatinumPremier (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

What type of plan is Network PlatinumPremier (PPO)

Network PlatinumPremier (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 PlatinumPremier (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 $177.00 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 PlatinumPremier (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 PlatinumPremier (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

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Contact lenses

Vision	Not covered

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Eyeglass frames

Vision	Not covered

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Eyeglass lenses

Vision	Not covered

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Eyeglasses (frames and lenses)

Vision	Not covered

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Other

Vision	Not covered

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Routine eye exam

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

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Upgrades

Vision	Not covered

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Transportation	Not covered
In-Network Skilled Nursing Facility	$0 copay
Out-of-Network Skilled Nursing Facility	$0 copay

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Occupational therapy visit

In-Network Rehabilitation services	$20 copay
Out-of-Network Rehabilitation services	$20 copay

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Physical therapy and speech and language therapy visit

Out-of-Network Rehabilitation services	$20 copay
In-Network Rehabilitation services	$20 copay

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Cleaning

Preventive dental	Covered under office visit

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Dental x-ray(s)

Preventive dental	Not covered

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Fluoride treatment

Preventive dental	Not covered

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Office visit

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

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Oral exam

Preventive dental	Covered under office visit

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In-Network Preventive care	$0 copay
Out-of-Network Preventive care	$0 copay
Out-of-Network Outpatient hospital coverage	$0 copay
In-Network Outpatient hospital coverage	$0 copay
In-Network Other health plan deductibles?	No
Optional supplemental benefits	Yes

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Inpatient hospital - psychiatric

Out-of-Network Mental health services	$0 copay per stay
In-Network Mental health services	$0 copay

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Outpatient group therapy visit

Out-of-Network Mental health services	$0 copay
In-Network Mental health services	$0 copay

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Outpatient group therapy visit with a psychiatrist

Out-of-Network Mental health services	$0 copay
In-Network Mental health services	$0 copay

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Outpatient individual therapy visit

In-Network Mental health services	$0 copay
Out-of-Network Mental health services	$0 copay

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Outpatient individual therapy visit with a psychiatrist

In-Network Mental health services	$0 copay
Out-of-Network Mental health services	$0 copay

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Chemotherapy

In-Network Medicare Part B drugs	20% coinsurance
Out-of-Network Medicare Part B drugs	20% coinsurance

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Other Part B drugs

In-Network Medicare Part B drugs	20% coinsurance
Out-of-Network Medicare Part B drugs	20% coinsurance

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Diabetes supplies

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

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

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

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

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

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$3,400 In and Out-of-network $3,400 In-network
Out-of-Network Inpatient hospital coverage	$75 per day for days 1 through 5 $0 per day for days 6 and beyond
In-Network Inpatient hospital coverage	$75 per day for days 1 through 5 $0 per day for days 6 through 90

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Fitting/evaluation

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

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Hearing aids

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

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Hearing exam

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

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

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Foot exams and treatment

Out-of-Network Foot care (podiatry services)	$20 copay
In-Network Foot care (podiatry services)	$20 copay

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Routine foot care

Foot care (podiatry services)	Not covered

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Emergency

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

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Urgent care

Emergency care/Urgent care	$20 copay per visit (always covered)

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Primary

In-Network Doctor visits	$10 copay per visit
Out-of-Network Doctor visits	$10 copay per visit

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Specialist

In-Network Doctor visits	$20 copay per visit
Out-of-Network Doctor visits	$20 copay per visit

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Diagnostic radiology services (e.g., MRI)

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

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Diagnostic tests and procedures

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

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Lab services

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

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Outpatient x-rays

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

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Diagnostic services

Comprehensive dental	Not covered

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Endodontics

Comprehensive dental	Not covered

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Extractions

Comprehensive dental	Not covered

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Non-routine services

Comprehensive dental	Not covered

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Periodontics

Comprehensive dental	Not covered

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Prosthodontics, other oral/maxillofacial surgery, other services

Comprehensive dental	Not covered

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Restorative services

Comprehensive dental	Not covered

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

Network PlatinumPremier (PPO) Reviews

Is Network PlatinumPremier (PPO) a good plan? Network PlatinumPremier (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 PlatinumPremier Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H5215-006 Health Plan

Member Complaints and Changes in Plans Performance

Health Plan Customer Service Rating for Network Health Medicare Advantage Plans

Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

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 PlatinumPremier (PPO) requires you to live in that plan’s service area. The service area is listed below:

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

Last updated on December 03, 2022

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.