Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO)

H9834 - 001 - 0
5 out of 5 stars (5 / 5)

quartz-medicare-advantage medicare provider logo

Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO) is a Medicare Advantage (Part C) Plan by Quartz Medicare Advantage.

This page features plan details for 2023 Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO) H9834 – 001 – 0 available in Counties: Fillmore, Houston, Wabasha, Winona.

IMPORTANT: This page has been updated with plan and premium data for the 2023 Medicare Annual Enrollment Period (AEP).

Locations

Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO) is offered in the following locations.

Plan Overview

Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO) offers the following coverage and cost-sharing.

Insurer:Quartz Medicare Advantage
Health Plan Deductible:$0.00
MOOP:$3,000 In-network
Drugs Covered:Yes

Ready to sign up for Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO) ?

Get help from a licensed Medicare agent.

Click to Call 1-877-354-4611 TTY 711. Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.

Premium Breakdown

Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO) has a monthly premium of $152.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$164.90 $108.10 $43.90 $0.00 $316.90
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Initial Coverage Limit: $4,660.00
Catastrophic Coverage Limit: $7,400.00
Drug Benefit Type: Enhanced
Gap Coverage: Yes
Formulary Link: Formulary Link

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs. The table below shows how the LIS impacts the Part D premium of this plan.
Part D LIS 25% LIS 50% LIS 75% LIS Full
$43.90 $33.90 $24.00 $14.00 $4.00

Initial Coverage Phase

After you pay your $0.00 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 $4,660.00. Once you reach that amount, you will enter the next coverage phase.

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.

Tier Cost
All other tiers (Generic)25%
All other tiers (Brand-name)25%

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.

Drug TypeCost Share
Generic drugs$4.15 copay or 5% (whichever costs more)
Brand-name drugs$10.35 copay or 5% (whichever costs more)

Additional Benefits

Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-Network: Yes, contact plan for further details

Dental (comprehensive)

Diagnostic services: $0 copay (limits may apply) (authorization not required) (referral not required)
Endodontics: $0 copay (limits may apply) (authorization not required) (referral not required)
Extractions: $0 copay (limits may apply) (authorization not required) (referral not required)
Non-routine services: $0 copay (limits may apply) (authorization not required) (referral not required)
Periodontics: $0 copay (limits may apply) (authorization not required) (referral not required)
Prosthodontics, other oral/maxillofacial surgery, other services: $0 copay (limits may apply) (authorization not required) (referral not required)
Restorative services: $0 copay (limits may apply) (authorization not required) (referral not required)

Dental (preventive)

Cleaning: $0 copay (limits may apply) (authorization not required) (referral not required)
Dental x-ray(s): $0 copay (limits may apply) (authorization not required) (referral not required)
Fluoride treatment: $0 copay (limits may apply) (authorization not required) (referral not required)
Oral exam: $0 copay (limits may apply) (authorization not required) (referral not required)

Diagnostic procedures/lab services/imaging

Diagnostic radiology services (e.g., MRI): $50 copay (authorization required) (referral not required)
Diagnostic tests and procedures: $4 copay (authorization not required) (referral not required)
Lab services: $4 copay (authorization not required) (referral not required)
Outpatient x-rays: $4 copay (authorization required) (referral not required)

Doctor visits

Primary: $5 copay per visit
Specialist: $30 copay per visit (authorization not required) (referral not required)

Emergency care/Urgent care

Emergency: $110 copay per visit (always covered)
Urgent care: $30 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment: $30 copay (authorization not required) (referral not required)
Routine foot care: $30 copay (limits may apply) (authorization not required) (referral not required)

Ground ambulance

$225 copay

Health plan deductible

$0.00

Health plan deductibles (other)

In-Network: No

Hearing

Fitting/evaluation: Not covered (no limits)
Hearing aids: $0 copay (limits may apply) (authorization not required) (referral not required)
Hearing exam: $15 copay (authorization not required) (referral not required)

Hospital coverage (inpatient)

$250 per stay (authorization not required) (referral not required)

Hospital coverage (outpatient)

$0-100 copay per visit (authorization not required) (referral not required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$3,000 In-network

Medical equipment/supplies

Diabetes supplies: $0 copay (authorization not required)
Durable medical equipment (e.g., wheelchairs, oxygen): 20% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs): 20% coinsurance per item (authorization required)

Medicare Part B drugs

Chemotherapy: 15% coinsurance (authorization required)
Other Part B drugs: 15% coinsurance (authorization required)

Mental health services

Inpatient hospital – psychiatric: $250 per stay (authorization not required) (referral not required)
Outpatient group therapy visit: $20 copay (authorization not required) (referral not required)
Outpatient group therapy visit with a psychiatrist: $20 copay (authorization not required) (referral not required)
Outpatient individual therapy visit: $20 copay (authorization not required) (referral not required)
Outpatient individual therapy visit with a psychiatrist: $20 copay (authorization not required) (referral not required)

Optional supplemental benefits

Yes

Preventive care

$0 copay (authorization not required) (referral not required)

Rehabilitation services

Occupational therapy visit: $10 copay (authorization required) (referral not required)
Physical therapy and speech and language therapy visit: $10 copay (authorization required) (referral not required)

Skilled Nursing Facility

$0 per day for days 1 through 20
$150 per day for days 21 through 100 (authorization required) (referral not required)

Transportation

$0 copay (no limits) (authorization not required) (referral not required)

Vision

Contact lenses: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass frames: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass lenses: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglasses (frames and lenses): $0 copay (limits may apply) (authorization not required) (referral not required)
Other: $0 copay (limits may apply) (authorization not required) (referral not required)
Routine eye exam: $0 copay (limits may apply) (authorization not required) (referral not required)
Upgrades: $0 copay (limits may apply) (authorization not required) (referral not required)

Wellness programs (e.g., fitness, nursing hotline)

Covered (authorization required) (referral not required)

Optional Benefits

Package #1

Preventive dental:Monthly Premium:$38.00
Preventive dental:Deductible:N/A
Comprehensive dental:Monthly Premium:$38.00
Comprehensive dental:Deductible:N/A

Ready to sign up for Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO) ?

Get help from a licensed Medicare agent.

Click to Call 1-877-354-4611 TTY 711. Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.

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