Network Health 2024 Medicare Advantage PPO plans are rated 5 out of 5 stars by Medicare. Learn more.

Individual and Family Plans

Signature Prestige Bronze Copay + Dental + Vision

Our best selling plan, it is designed for individuals looking for low monthly premiums and quality coverage. Signature Prestige Bronze Copay provides preventive services for $0. In addition, you get a $0 annual vision exam and two dental exams for each covered member. This plan also features copayments without deductibles.

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Signature Prestige Bronze Copay Plan Highlights
DEDUCTIBLE	Individual	$0
DEDUCTIBLE	Family	$0
COINSURANCE		0%
OUT-OF- POCKET LIMIT	Individual	$9,100
OUT-OF- POCKET LIMIT	Family	$18,200
BENEFITS	Preventive Care	$0
	Routine Vision Exam	$0
	Annual Dental Exam	$0
	Personal Doctor Visit	$55 per visit
	Virtual Visit	$0 per visit
	Specialist Visit	$150 per visit
	Chiropractic	$75 per visit
	Hospital Stay	$1,500 per day for days 1 and 2
	Emergency Room	$2,000 per visit
	X-ray and Diagnostic Imaging	$150 per visit

Prescription Drug Coverage

All Network Health’s Prestige plans have built-in pharmacy benefits. See the chart below for prescription drug coverage information.

Signature Prestige Bronze Copay Pharmacy Benefit Highlights
Retail 30-Day supply Cost per prescription or refill	Preventive Drugs	$0
	Adherence Generics (limited only to categories of antidiabetics, statins, and RAS antagonists)	$0
	Tier 1 Generics	$30
	Tier 2 Preferred Brand Drugs	$160
	Tier 3 Non-Preferred Brand Drugs	50% coinsurance
	Tier 4 Preferred Specialty Drugs	40% coinsurance
	Tier 5 Non-Preferred Specialty Drugs	50% coinsurance

Copyright 2023 Network Health Medicare Advantage Plans include MSA, HMO and PPO plans with a Medicare contract. Network Health Cares is a PPO D-SNP plan with a Medicare contract and a contract with the Wisconsin Medicaid program. Enrollment in Network Health Medicare Advantage Plans depends on contract renewal. Each year, Medicare evaluates plans based on a 5-Star rating system. Out-of-network/non-contracted providers are under no obligation to treat Network Health members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Y0108_4790-01-0923_2024_C Last Updated Nov 20, 2023 3:23 PM

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Individual and Family Plans

Signature Prestige Bronze Copay + Dental + Vision

Signature Prestige Bronze Copay Plan Highlights

Prescription Drug Coverage

Signature Prestige Bronze Copay Pharmacy Benefit Highlights