NetworkPrime (MSA)
H1181 - 001 - 0
(3.5 / 5)
NetworkPrime (MSA) is a Medicare Advantage (Part C) Plan by Network Health Medicare Advantage Plans.
This page features plan details for 2023 NetworkPrime (MSA) H1181 – 001 – 0 available in Wisconsin.
IMPORTANT: This page features the 2023 version of this plan. See the 2024 version using the link below:
Locations
NetworkPrime (MSA) is offered in the following locations.
Plan Overview
NetworkPrime (MSA) offers the following coverage and cost-sharing.
| Insurer: | Network Health Medicare Advantage Plans |
| Health Plan Deductible: | $5,100 annual deductible |
| MOOP: | |
| 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 NetworkPrime (MSA) ?
Premium Breakdown
NetworkPrime (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 |
|---|---|---|---|
| $164.90 | $0.00 | $0.00 | $164.90 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
NetworkPrime (MSA) also provides the following benefits.
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
| In-Network: No |
Dental (comprehensive)
| 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 |
Dental (preventive)
| Cleaning: | Not covered |
| Dental x-ray(s): | Not covered |
| Fluoride treatment: | Not covered |
| Oral exam: | Not covered |
Diagnostic procedures/lab services/imaging
| Diagnostic radiology services (e.g., MRI): | $0 copay after you pay your deductible |
| Diagnostic tests and procedures: | $0 copay after you pay your deductible |
| Lab services: | $0 copay after you pay your deductible |
| Outpatient x-rays: | $0 copay after you pay your deductible |
Doctor visits
| Primary: | $0 copay after you pay your deductible |
| Specialist: | $0 copay after you pay your deductible |
Emergency care/Urgent care
| Emergency: | $0 copay after you pay your deductible |
| Urgent care: | $0 copay after you pay your deductible |
Foot care (podiatry services)
| Foot exams and treatment: | $0 copay after you pay your deductible |
| Routine foot care: | Not covered |
Ground ambulance
| $0 copay after you pay your deductible |
Health plan deductible
| $5,100 annual deductible |
Health plan deductibles (other)
| In-Network: No |
Hearing
| Fitting/evaluation: | Not covered |
| Hearing aids – inner ear: | Not covered |
| Hearing aids – outer ear: | Not covered |
| Hearing aids – over the ear: | Not covered |
| Hearing exam: | $0 copay after you pay your deductible |
Hospital coverage (inpatient)
| $0 copay after you pay your deductible |
Hospital coverage (outpatient)
| $0 copay after you pay your deductible |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| Not Applicable |
Medical equipment/supplies
| Diabetes supplies: | $0 copay after you pay your deductible |
| Durable medical equipment (e.g., wheelchairs, oxygen): | $0 copay after you pay your deductible |
| Prosthetics (e.g., braces, artificial limbs): | $0 copay after you pay your deductible |
Medicare Part B drugs
| Chemotherapy: | $0 copay after you pay your deductible |
| Other Part B drugs: | $0 copay after you pay your deductible |
Mental health services
| Inpatient hospital – psychiatric: | $0 copay after you pay your deductible |
| Outpatient group therapy visit: | $0 copay after you pay your deductible |
| Outpatient group therapy visit with a psychiatrist: | $0 copay after you pay your deductible |
| Outpatient individual therapy visit: | $0 copay after you pay your deductible |
| Outpatient individual therapy visit with a psychiatrist: | $0 copay after you pay your deductible |
Optional supplemental benefits
| Yes |
Preventive care
| $0 copay |
Rehabilitation services
| Occupational therapy visit: | $0 copay after you pay your deductible |
| Physical therapy and speech and language therapy visit: | $0 copay after you pay your deductible |
Skilled Nursing Facility
| $0 copay after you pay your deductible |
Transportation
| Not covered |
Vision
| 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 |
Wellness programs (e.g., fitness, nursing hotline)
| Not covered |
Optional Benefits
Package #1
| Preventive dental: | Monthly Premium: | $39.00 |
| Preventive dental: | Deductible: | $100.00 |
| Comprehensive dental: | Monthly Premium: | $39.00 |
| Comprehensive dental: | Deductible: | $100.00 |
Ready to sign up for NetworkPrime (MSA) ?