Network Health Prime (MSA)
H1181 - 001 - 0
(0 / 5)
Network Health Prime (MSA) is a Medicare Advantage (Part C) Plan by Network Health Medicare Advantage Plans.
This page features plan details for 2024 Network Health Prime (MSA) H1181 – 001 – 0 available in Wisconsin.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Network Health Prime (MSA) is offered in the following locations.
Plan Overview
Network Health Prime (MSA) offers the following coverage and cost-sharing.
| Insurer: | Network Health Medicare Advantage Plans |
| Health Plan Deductible: | $5,100 annual deductible |
| MOOP: | Not Applicable |
| Drugs Covered: | No |
Please Note:
- Additional restrictions apply to enrollment in an MSA plan. Please contact this plan to enroll. Once you reach the plan deductible, Medicare MSA plans cover Original Medicare benefits. Co-pay for Medicare MSAs is $0 once deductible is met.
- Please note, preventive services are also subject to satisfying your MSA plan deductible, so once you've met your deductible you'll then pay nothing
Ready to sign up for Network Health Prime (MSA) ?
Premium Breakdown
Network Health Prime (MSA) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $0.00 | $0.00 | $174.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Network Health Prime (MSA) also provides the following benefits.
| $5,100 annual deductible |
| In-network | No |
| Not Applicable |
| Yes |
| In-network | No |
| $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Primary | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Specialist | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| $0 copay (Not applicable.) (Not applicable.) |
| Emergency | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Urgent care | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Diagnostic tests and procedures | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Lab services | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Diagnostic radiology services (e.g., MRI) | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Outpatient x-rays | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Hearing exam | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Fitting/evaluation | Not covered (Not applicable.) (Not applicable.) |
| Hearing aids – inner ear | Not covered (Not applicable.) (Not applicable.) |
| Hearing aids – outer ear | Not covered (Not applicable.) (Not applicable.) |
| Hearing aids – over the ear | Not covered (Not applicable.) (Not applicable.) |
| Oral exam | Not covered (Not applicable.) (Not applicable.) |
| Cleaning | Not covered (Not applicable.) (Not applicable.) |
| Fluoride treatment | Not covered (Not applicable.) (Not applicable.) |
| Dental x-ray(s) | Not covered (Not applicable.) (Not applicable.) |
| Non-routine services | Not covered (Not applicable.) (Not applicable.) |
| Diagnostic services | Not covered (Not applicable.) (Not applicable.) |
| Restorative services | Not covered (Not applicable.) (Not applicable.) |
| Endodontics | Not covered (Not applicable.) (Not applicable.) |
| Periodontics | Not covered (Not applicable.) (Not applicable.) |
| Extractions | Not covered (Not applicable.) (Not applicable.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (Not applicable.) (Not applicable.) |
| Routine eye exam | Not covered (Not applicable.) (Not applicable.) |
| Other | Not covered (Not applicable.) (Not applicable.) |
| Contact lenses | Not covered (Not applicable.) (Not applicable.) |
| Eyeglasses (frames and lenses) | Not covered (Not applicable.) (Not applicable.) |
| Eyeglass frames | Not covered (Not applicable.) (Not applicable.) |
| Eyeglass lenses | Not covered (Not applicable.) (Not applicable.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
| Occupational therapy visit | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Physical therapy and speech and language therapy visit | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| Foot exams and treatment | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Prosthetics (e.g., braces, artificial limbs) | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Diabetes supplies | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| Chemotherapy | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Other Part B drugs | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Part B Insulin drugs | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Inpatient hospital – psychiatric | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Outpatient group therapy visit with a psychiatrist | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Outpatient individual therapy visit with a psychiatrist | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Outpatient group therapy visit | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Outpatient individual therapy visit | $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| $0 copay after you pay your deductible (Not applicable.) (Not applicable.) |
| Monthly Premium | $42.00 |
| Deductible | $100.00 |
Ready to sign up for Network Health Prime (MSA) ?
Table of Contents
SMID: MULTIPLAN_HCIHNDOGMED01_M
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