UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)

H5262 - 007 - 0
4.5 out of 5 stars (4.5 / 5)

UW Health Quartz Med Advantage Elite D (w/Rx) (HMO) is a Medicare Advantage Plan by Quartz Medicare Advantage.

This page features plan details for 2024 UW Health Quartz Med Advantage Elite D (w/Rx) (HMO) H5262 – 007 – 0 available in Southcentral Wisconsin.

IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:

No 2025 version found. You can use the location links below to find 2025 plans in your area.

Locations

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

Plan Overview

UW Health 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:$3,450 In-network
Drugs Covered:Yes
Please Note:
  • This plan does not charge an annual deductible for all drugs. The $200.00 annual deductible only applies to drugs on certain tiers.

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

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

UW Health Quartz Med Advantage Elite D (w/Rx) (HMO) has a monthly premium of $124.00. 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
$174.70 $64.40 $59.60 $0.00 $298.70
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

UW Health 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:$200.00
Initial Coverage Limit:$5,030.00
Catastrophic Coverage Limit:$8,000.00
Drug Benefit Type:Enhanced Alternative
Additional 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 DLIS Full
$59.60$

Initial Coverage Phase

After you pay your $200.00 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 $5,030.00. Once you reach that amount, you will enter the next coverage phase.

Gap Coverage Phase

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 $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

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

Health plan deductible

$0

Other health plan deductibles?

In-network No

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

$3,450 In-network

Optional supplemental benefits

Yes

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

In-network Yes, contact plan for further details

Outpatient hospital coverage

$0-200 copay per visit (Authorization is required.) (Referral is not required.)

Doctor visits

Primary$5 copay per visit (Not applicable.) (Not applicable.)
Specialist$35 copay per visit (Authorization is not required.) (Referral is not required.)

Preventive care

$0 copay (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$120 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$35 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures$10 copay (Authorization is required.) (Referral is not required.)
Lab services$10 copay (Authorization is required.) (Referral is not required.)
Diagnostic radiology services (e.g., MRI)$125 copay (Authorization is not required.) (Referral is not required.)
Outpatient x-rays$20 copay (Authorization is not required.) (Referral is not required.)

Hearing

Hearing exam$25 copay (Authorization is not required.) (Referral is not required.)
Fitting/evaluationNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Hearing aids$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Preventive dental

Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Fluoride treatment$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

Non-routine services$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Diagnostic services$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Restorative services$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Endodontics$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Periodontics$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Extractions$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Vision

Routine eye exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Other$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglass frames$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglass lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Upgrades$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Rehabilitation services

Occupational therapy visit$40 copay (Authorization is required.) (Referral is not required.)
Physical therapy and speech and language therapy visit$40 copay (Authorization is required.) (Referral is not required.)

Ground ambulance

$250 copay (Not applicable.) (Not applicable.)

Transportation

$0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)

Foot care (podiatry services)

Foot exams and treatment$25 copay (Authorization is not required.) (Referral is not required.)
Routine foot care$25 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Medical equipment/supplies

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

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

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

Chemotherapy0-20% coinsurance (Authorization is required.) (Not applicable.)
Other Part B drugs0-20% coinsurance (Authorization is required.) (Not applicable.)
Part B Insulin drugs$35 copay (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

$300 per stay (Authorization is required.) (Referral is not required.)

Mental health services

Inpatient hospital – psychiatric$300 per stay (Authorization is required.) (Referral is not required.)
Outpatient group therapy visit with a psychiatrist$35 copay (Authorization is not required.) (Referral is not required.)
Outpatient individual therapy visit with a psychiatrist$35 copay (Authorization is not required.) (Referral is not required.)
Outpatient group therapy visit$35 copay (Authorization is not required.) (Referral is not required.)
Outpatient individual therapy visit$35 copay (Authorization is not required.) (Referral is not required.)

Skilled Nursing Facility

$0 per day for days 1 through 20
$170 per day for days 21 through 100 (Authorization is required.) (Referral is not required.)

Package #1

Monthly Premium$36.00
Deductiblenan

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 UW Health Quartz Med Advantage Elite D (w/Rx) (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Table of Contents