NetworkCares (PPO D-SNP) By Network Health Medicare Advantage Plans
NetworkCares (PPO D-SNP) H5215 007 0 is a 2023 Medicare Advantage Special Needs Plan plan by Network Health Medicare Advantage Plans. This plan from Network Health Medicare Advantage Plans works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Network Health Medicare Advantage Plans and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage.
NetworkCares (PPO D-SNP) H5215-007 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.
The NetworkCares (PPO D-SNP) H5215-007 is available to residents to
Medicare eligible seniors in Wisconsin.
All Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage.
NetworkCares (PPO D-SNP) 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 NetworkCares (PPO D-SNP) 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 $0 Part-C 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.
Part-D Deductible and Premium
An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. NetworkCares (PPO D-SNP) has a monthly drug premium of $43.10 and a $505.00 drug deductible. This Network Health Medicare Advantage Plans plan offers a $43.10 Part-D Basic Premium that is below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0. This Premium covers any enhanced plan benefits offered by Network Health Medicare Advantage Plans above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $43.10. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.
Network Health Medicare Advantage Plans Gap Coverage
In 2023 once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Network Health Medicare Advantage Plans plan does not offer additional coverage through the gap.
Extra Help Premium Assistance
The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The NetworkCares (PPO D-SNP) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $10.80 for 75% low-income subsidy $21.50 for 50% and $32.30 for 25%.
Full Assistance Premium:
$0
75% Assistance Premium:
$10.80
50% Assistance Premium:
$21.50
25% Assistance Premium:
$32.30
H5215-007 Formulary and Drug Coverage
NetworkCares (PPO D-SNP) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.
By reviewing different Medicare Drug formularies, you can pick a Medicare Special Needs Plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
The benefit information provided is a summary of what NetworkCares (PPO D-SNP) 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.
In 2023 the amounts for each benefit period are: $0 copay for days 1 through 20 $200 copay per day for days 21 through 100
In-Network Skilled Nursing Facility
In 2023 the amounts for each benefit period are $0 or: $0 copay for days 1 through 20 $200 copay per day for days 21 through 100
Occupational therapy visit
In-Network Rehabilitation services
0% or 20% coinsurance
Out-of-Network Rehabilitation services
20% coinsurance
Physical therapy and speech and language therapy visit
Out-of-Network Rehabilitation services
20% coinsurance
In-Network Rehabilitation services
0% or 20% coinsurance
Cleaning
Out-of-Network Preventive dental
$0 copay
In-Network Preventive dental
$0 copay
Dental x-ray(s)
In-Network Preventive dental
$0 copay
Out-of-Network Preventive dental
$0 copay
Fluoride treatment
Out-of-Network Preventive dental
$0 copay
In-Network Preventive dental
$0 copay
Oral exam
Out-of-Network Preventive dental
$0 copay
In-Network Preventive dental
$0 copay
In-Network Preventive care
$0 copay
Out-of-Network Preventive care
20% coinsurance
In-Network Outpatient hospital coverage
0% or 20% coinsurance per visit
Out-of-Network Outpatient hospital coverage
20% coinsurance per visit
In-Network Other health plan deductibles?
No
Optional supplemental benefits
No
Inpatient hospital - psychiatric
In-Network Mental health services
In 2023 the amounts for each benefit period are $0 or: $1,600 deductible for days 1 through 60 $400 copay per day for days 61 through 90
Out-of-Network Mental health services
In 2023 the amounts for each benefit period are: $1,600 deductible for days 1 through 60 $400 copay per day for days 61 through 90
Outpatient group therapy visit
Out-of-Network Mental health services
20% coinsurance
In-Network Mental health services
0% or 20% coinsurance
Outpatient group therapy visit with a psychiatrist
Out-of-Network Mental health services
20% coinsurance
In-Network Mental health services
0% or 20% coinsurance
Outpatient individual therapy visit
In-Network Mental health services
0% or 20% coinsurance
Out-of-Network Mental health services
20% coinsurance
Outpatient individual therapy visit with a psychiatrist
Out-of-Network Mental health services
20% coinsurance
In-Network Mental health services
0% or 20% coinsurance
Chemotherapy
In-Network Medicare Part B drugs
0% or 20% coinsurance
Out-of-Network Medicare Part B drugs
20% coinsurance
Other Part B drugs
In-Network Medicare Part B drugs
0% or 20% coinsurance
Out-of-Network Medicare Part B drugs
20% coinsurance
Diabetes supplies
Out-of-Network Medical equipment/supplies
20% coinsurance per item
In-Network Medical equipment/supplies
0% or 20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)
In-Network Medical equipment/supplies
0% or 20% coinsurance per item
Out-of-Network Medical equipment/supplies
20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)
In-Network Medical equipment/supplies
0% or 20% coinsurance per item
Out-of-Network Medical equipment/supplies
20% coinsurance per item
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$12,450 In and Out-of-network $8,300 In-network
Out-of-Network Inpatient hospital coverage
In 2023 the amounts for each benefit period are: $1,600 deductible for days 1 through 60 $400 copay per day for days 61 through 90
In-Network Inpatient hospital coverage
In 2023 the amounts for each benefit period are $0 or: $1,600 deductible for days 1 through 60 $400 copay per day for days 61 through 90
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
0% or 20% coinsurance
Out-of-Network Hearing
20% coinsurance
Health plan deductible
$0 or $1,600 per year for inpatient hospital services and $0 or $226 for outpatient services with a total plan deductible of $0 or $1,826 per year from in-network and out-of-network providers.
Prosthodontics, other oral/maxillofacial surgery, other services
In-Network Comprehensive dental
50% coinsurance
Out-of-Network Comprehensive dental
0-50% coinsurance
Restorative services
In-Network Comprehensive dental
0-50% coinsurance
Out-of-Network Comprehensive dental
0-50% coinsurance
In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
No
CMS Star Ratings
Is NetworkCares (PPO D-SNP) a good plan? NetworkCares (PPO D-SNP) received 5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Special Needs 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 NetworkCares (PPO D-SNP) performance 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 H5215-007 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 Special Need 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 NetworkCares (PPO D-SNP) requires you to live in that plan’s service area. The service area is listed below:
Notes: Data are subject to change. All contracts for 2023 have not been finalized. For 2023, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.
Includes 2023 approved contracts/plans. Employer sponsored 800 series plans 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.
