Cooperative Advantage (HMO I-SNP) is a Medicare Advantage (Part C) Special Needs Plan by Group Health Cooperative of Eau Claire.
This page features plan details for 2022 Cooperative Advantage (HMO I-SNP) H7598 – 002 – 0 available in Wisconsin.
Cooperative Advantage (HMO I-SNP) is offered in the following locations.
Cooperative Advantage (HMO I-SNP) offers the following coverage and cost-sharing.
| Special Needs Plan Type: | Institutional |
| Conditions Covered: |
| Insurer: | Group Health Cooperative of Eau Claire |
| Health Plan Deductible: | |
| MOOP: | $7,550 In-network |
| Drugs Covered: | Yes |
Ready to sign up for Cooperative Advantage (HMO I-SNP) ?
| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $170.10 | $0.00 | $42.30 | $0.00 | $212.40 |
Cooperative Advantage (HMO I-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $480.00 |
| Initial Coverage Limit: | $4,430.00 |
| Catastrophic Coverage Limit: | $7,050.00 |
| Drug Benefit Type: | Basic |
| Gap Coverage: | No Gap Coverage |
| Formulary Link: | Formulary Link |
| Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
|---|---|---|---|---|
| $42.30 | $31.70 | $21.20 | $10.60 | $0.00 |
After you pay your $480.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,430.00. Once you reach that amount, you will enter the next coverage phase.
After your total drug costs (including what this plan has paid and what you have paid) reach $4,430.00, you will pay no more than the amounts below for any drug tier until you reach $7,050.00.
| Drug Type | Cost Share |
|---|---|
| Generic drugs | 25% |
| Brand-name drugs | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
| Drug Type | Cost Share |
|---|---|
| Generic drugs | $3.95 copay or 5% (whichever costs more) |
| Brand-name drugs | $9.85 copay or 5% (whichever costs more) |
Cooperative Advantage (HMO I-SNP) also provides the following benefits.
| In-Network: No |
| Diagnostic services: | Not covered |
| Endodontics: | Not covered |
| Extractions: | Not covered |
| Non-routine services: | Not covered |
| Periodontics: | Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other services: | Not covered |
| Restorative services: | Not covered |
| Cleaning: | Not covered |
| Dental x-ray(s): | Not covered |
| Fluoride treatment: | Not covered |
| Oral exam: | Not covered |
| Diagnostic radiology services (e.g., MRI): | 20% coinsurance |
| Diagnostic tests and procedures: | 20% coinsurance |
| Lab services: | $0 copay |
| Outpatient x-rays: | 20% coinsurance |
| Primary: | 20% coinsurance per visit |
| Specialist: | 20% coinsurance per visit |
| Emergency: | 20% coinsurance per visit (always covered) |
| Urgent care: | 20% coinsurance per visit (always covered) |
| Foot exams and treatment: | 20% coinsurance |
| Routine foot care: | Not covered |
| 20% coinsurance |
| Contact plan for details |
| In-Network: No |
| Fitting/evaluation: | Not covered |
| Hearing aids: | $250 copay (limits may apply) |
| Hearing exam: | 20% coinsurance |
| Contact plan for details |
| 20% coinsurance per visit |
| $7,550 In-network |
| Diabetes supplies: | 20% coinsurance per item |
| Durable medical equipment (e.g., wheelchairs, oxygen): | 20% coinsurance per item |
| Prosthetics (e.g., braces, artificial limbs): | 20% coinsurance per item |
| Chemotherapy: | 20% coinsurance |
| Other Part B drugs: | 20% coinsurance |
| Inpatient hospital – psychiatric: | Contact plan for details |
| Outpatient group therapy visit with a psychiatrist: | 20% coinsurance |
| Outpatient group therapy visit: | 20% coinsurance |
| Outpatient individual therapy visit with a psychiatrist: | 20% coinsurance |
| Outpatient individual therapy visit: | 20% coinsurance |
| No |
| $0 copay |
| Occupational therapy visit: | 20% coinsurance |
| Physical therapy and speech and language therapy visit: | 20% coinsurance |
| Contact plan for details |
| Not covered |
| Contact lenses: | Not covered |
| Eyeglass frames: | Not covered |
| Eyeglass lenses: | Not covered |
| Eyeglasses (frames and lenses): | Not covered |
| Other: | Not covered |
| Routine eye exam: | Not covered |
| Upgrades: | Not covered |
| Not covered |
Ready to sign up for Cooperative Advantage (HMO I-SNP) ?
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
SMID: MULTIPLAN_HCIHNDOGMED01_M
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