Skip to main content

Plan Details

Network Health Cares (PPO D-SNP)

Medical and pharmacy coverage for people who have both Medicare and Medicaid benefits.

_

Premium

$0 a month

Enroll Now
Enroll Now
  • You pay the same in- and out-of-network for medical benefits (unless specified)
  • $0 copayment for an annual in-network routine hearing exam
  • $50 HRA reward
  • $192 quarterly over-the-counter benefit
  • $400 allowance for glasses and contacts
  • One Pass™ fitness
  • Transportation benefit
  • $0 monthly premium
  • 100% coverage for preventive care
  • Comprehensive and preventive dental
  • Meal delivery after an inpatient or skilled nursing facility stay
  • Regular contact from specialized care coordinators
  • Must qualify for Medicaid to enroll in this plan

Additional Benefits

Over-the-Counter Allowance

To keep you healthy and well, our Network Health Cares members receive a $192 per quarter over-the-counter allowance. Hundreds of useful items can be mailed directly to your home at no cost to you.

Meals

Recovering after an inpatient stay can be difficult. That’s why Network Health partners with Mom’s Meals to provide Network Health Cares members with 28 delicious meals delivered right to your door after a qualifying inpatient hospital stay, a hospital observation or a skilled nursing facility stay.

In-Home Support

Network Health offers you access to a network of friendly helpers that provide you support with daily activities such as household tasks, technology help, transportation, shopping, meal preparation and more. You receive 120 hours of in-home support services per year. 

HRA Reward

You can receive $50, once per year, for completing your health risk assessment (HRA).

Dental

Protecting your teeth and gums should be as routine as your annual wellness visit. Network Health partners with Say Cheese Dental Network to offer Network Health Cares members preventive and comprehensive dental care. For a summary of what's included and frequently asked questions, click here. Visit the Say Cheese Dental Network website to Find a Dental Provider.

Vision

Annual vision exams are an important part of your health care, so we partner with EyeMed® to offer our Network Health Cares members an annual in-network routine vision exam for a $0 copayment and up to $400 for eyewear. For a summary of what’s included and frequently asked questions, click here. Visit EyeMed's website to Find a Vision Provider.

Hearing

We partner with TruHearing® to offer you a hearing benefit, so you can enjoy the world around you. Your hearing benefit includes an annual in-network routine hearing exam at a local TruHearing provider for $0. You also have access to select high-quality hearing aids, hearing aid fittings and follow-up care for $495-$1,695 per device when purchased through TruHearing. We recommend checking your Medicaid hearing benefit prior to using this benefit. Medicaid may cover a hearing exam and hearing aids for you.

 

Dual-Eligible Special Needs Plan PPO Benefits

Network Health Cares (PPO D-SNP)

Monthly Premium
$0
Annual Medical Deductible
In 2026 the amounts were:
$0-$283 depending on your level of Medicaid eligibility.
These amounts may change for 2027.
Annual Maximum Out-of-Pocket

(Does not include Part D prescription drugs)

$9,850 for services you receive from in-network
providers
$14,800 for services you receive from any provider,
your limit for services received from in-network providers will count toward this limit
Primary Care Provider Visit
0%-20% of the allowed amount
Specialist Visit
0%-20% of the allowed amount
Preventive Care*
$0 in-network
0%-20% of the allowed amount out-of-network
Annual Medicare Wellness Visit
Covered
Medicare-Covered Vaccines

Flu, pneumonia, COVID-19

$0
Medicare-Covered Vaccines

Hepatitis B1, all other Part B vaccines

$0 in-network
0%-20% of the allowed amount out-of-network
Inpatient Hospital Services1

Per admission

In 2026 the amounts for each admission were
Days 1-60 $0-$1,736 deductible
Days 61-90 $0-$434 per day
Days 91 and beyond $0-$868 per day
(This plan covers 60 lifetime reserve days)
These amounts may change for 2027.
Outpatient Hospital Services1
0%-20% of the allowed amount
Labs
0%-20% of the allowed amount
Diagnostic Tests1

Such as ultrasound, EKG, stress test

0%-20% of the allowed amount
X-rays
0%-20% of the allowed amount
Diagnostic Radiology Services– Advanced Imaging1
0%-20% of the allowed amount
Urgent Care Visit
0%-20% of the allowed amount, up to $40
Emergency Room Visit
0%-20% of the allowed amount, up to $130
Air and Ground Ambulance Services
0%-20% of the allowed amount
Durable Medical Equipment

Such as insulin pumps1, CPAP machines, prosthetic devices1

0%-20% of the allowed amount
Physician Telehealth Services
Virtual primary care and urgent care services cost the same as an in-person visit
Virtual Visit with MDLIVE ® 2

For medical services

$0
Medicare Part B Drugs 1
0-20% of the cost
Medicare Part D Drugs¹
Covered
Travel within the United States
Receive in-network coverage when you see a provider outside Wisconsin, anywhere in the United States
International Emergency Coverage

View the Evidence of Coverage at networkhealth.com/medicare/plan-materials for details

$130 per incident
$100,000
Maximum benefit
Preventive and Comprehensive Dental Coverage2
$0 Cleaning (twice a year)
$0 Dental X-ray(s) (bitewing 1 per year, full mouth 1 every 5 years)
$0 Oral exam (twice a year)
$0 Basic restorative services
$0 of the cost for major services received at in-network providers (endodontics/periodontics/extractions, prosthodontics, other oral/maxillofacial surgery, other services), member pays 50% coverage of the allowed amount out-of-network
$3,000 annual maximum
Medicare-Covered Dental Services

Does not include services in connection with care, treatment, filling, removal or replacement of teeth

0%-20% of the allowed amount
Annual Routine Vision Exam 2
$0 in-network, or
$40 reimbursement out-of-network
Diagnostic Eye Exam

To diagnose and treat diseases and conditions of the eye

0%-20% of the allowed amount
Post-Cataract Eyewear

One pair of eyeglasses or contact lenses after each cataract surgery

0%-20% of the cost
Additional Eyewear2
$400 allowance in-network at EyeMed providers
$400 reimbursement out-of-network
Over-the-Counter Catalog 2
Two order per quarter
$192 per quarter
No rollover on quarterly allowance.
Fitness with One Pass™ 2
In-Network: $0
Routine Hearing Exam 2
In-Network: $0
Diagnostic Hearing Exam

Exam to diagnose and treat hearing issues

0%-20% of the allowed amount
Fitting/Evaluation for Hearing Aids
In-Network: $0
Hearing Aids 2

Maximum of two hearing aids per year
Hearing aid evaluation with TruHearing and fitting included in-network

$495-$1,695 per device
Hearing aids must be purchased through TruHearing
Non-Emergency Transportation
Up to 52 one-way trips to and from approved locations anywhere within the Network Health Medicare Advantage service area
Meal Delivery

Following a qualified hospital observation stay, inpatient hospital stay or skilled nursing facility stay

28 meals
In-Home Support Services
120 hours annually through Helper Bees
HRA Reward
Earn a $50 health reward, per year, by completing your annual health risk assessment
Outpatient Mental Health

Individual or group therapy

0%-20% of the allowed amount
Inpatient Mental Health1

Per admission

In 2026 the amounts for each admission were
Days 1-60 $0-$1,736 deductible
Days 61-90 $0-$434 per day+
Days 91 and beyond $0-$868 per day
(This plan covers 60 lifetime reserve days)
These amounts may change for 2027.
Opioid Treatment Services
0%-20% of the allowed amount
Substance Abuse Services

Outpatient individual or group therapy

0%-20% of the allowed amount
Skilled Nursing Facility 1

Per admission

In 2026 the amounts were
$0 per day, days 1-20
$0-$217 per day, days 21-100
These amounts may change for 2027.
Outpatient Physical 1, Occupational 1, Speech Therapy
0%-20% of the allowed amount
Medicare-Covered Chiropractic Services

Manipulation of the spine to correct misalignment of one or more of the bones of your spine

0%-20% of the allowed amount
Medicare-Covered Acupuncture

For chronic low back pain only, up to 12 visits in 90 days and no more than 20 visits per year

0%-20% of the allowed amount
Medicare-Covered Home Health Care Visits 1
$0
Chemotherapy 1
0%-20% of the allowed amount
Radiation Therapy 1

Per service

0%-20% of the allowed amount
Diabetes Monitoring Supplies and Test Strips

Accu-Chek™ and FreeStyle™ test strips
FreeStyle Libre® and Dexcom® continuous glucose monitoring devices and supplies1 obtained through your pharmacy. Must have diabetic diagnosis. All other brands not covered.

0%-20% of the allowed amount
Diabetic Shoe Inserts

Coinsurance per pair

0%-20% of the allowed amount
Part B Insulin1

One month supply

No more than $35
Diabetes Management

Diabetes self-management training teaches you to cope with and manage your diabetes

0-20% of the allowed amount
Dialysis

Per treatment

0%-20% of the allowed amount
1 Service may require prior authorization.
2 Visit networkhealth.com/medicare/extra-benefits-snp for more information.
*Includes abdominal aortic aneurysm screening, alcohol misuse screening and counseling, annual wellness visit, bone mass measurement, breast cancer screening, cardiovascular disease screening, cardiovascular disease risk reduction visit, cervical and vaginal cancer screening, colorectal cancer screening (screening colonoscopy, fecal occult blood test, flexible sigmoidoscopy), depression screening, diabetes screening, glaucoma screening, HIV screening, lung cancer screening, medical nutrition therapy services, Medicare Diabetes Prevention Program, obesity screening and therapy, prostate cancer screening, screening for sexually transmitted infections and counseling, smoking and tobacco use cessation counseling, one time Welcome to Medicare preventive visit.
Because covered services and copayments could change, you should ask your provider what your copayment amount will be. If you get more than one service during the same appointment, you may be asked for more than one copayment.

 Your Drug Costs

Network Health Cares (PPO D-SNP)

After you reach your yearly deductible of $0-$700 for your Tier 1 drugs (all drugs), you pay the following coinsurance for your drugs. If you receive Extra Help, depending on your income level, your actual cost share may be less. You will need to fill your prescriptions at in-network retail pharmacies or the plan’s mail order pharmacy.
How much do I pay? 
For Part B drugs such as chemotherapy drugs1:
• In- and out-of-network: 0%-20% of the cost
Other Part B drugs1:
• In- and out-of-network: 0%-20% of the cost
Part D Prescription Drug Deductible
Tier 1 (all drugs): $700
30-Day Supply Pharmacy or Mail Order Pharmacy
25% of the total cost
3-Month Supply Pharmacy or Mail Order Pharmacy
25% of the total cost
Catastrophic Coverage
You enter catastrophic coverage when your total out-of-pocket costs reach $2,400. You pay $0.
Part D Insulin1
One-month supply
No more than $35
Part D Vaccines
Shingrix, RSV, all other recommended vaccines by the Advisory Committee on Immunization Practices
$0

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.

Enroll Now