UW Health Quartz Med Advantage Value (HMO)

H5262 - 009 - 0
4.5 out of 5 stars (4.5 / 5)

UW Health Quartz Med Advantage Value (HMO) is a Medicare Advantage (Part C) Plan by Quartz Medicare Advantage.

This page features plan details for 2024 UW Health Quartz Med Advantage Value (HMO) H5262 – 009 – 0 available in Southcentral Wisconsin.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

UW Health Quartz Med Advantage Value (HMO) is offered in the following locations.

Plan Overview

UW Health Quartz Med Advantage Value (HMO) offers the following coverage and cost-sharing.

Insurer:Quartz Medicare Advantage
Health Plan Deductible:$0.00
MOOP:$4,600 In-network
Drugs Covered:No

Ready to sign up for UW Health Quartz Med Advantage Value (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

Premium Breakdown

UW Health Quartz Med Advantage Value (HMO) has a monthly premium of $20.00. 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 $20.00 $0.00 $194.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

UW Health Quartz Med Advantage Value (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)

$4,600 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

$0-400 copay per visit (Authorization is required.) (Referral is not required.)

Doctor visits

Primary$10 copay per visit (Not applicable.) (Not applicable.)
Specialist$45 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$45 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures$15 copay (Authorization is required.) (Referral is not required.)
Lab services$15 copay (Authorization is required.) (Referral is not required.)
Diagnostic radiology services (e.g., MRI)$150 copay (Authorization is not required.) (Referral is not required.)
Outpatient x-rays$25 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

$275 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$35 copay (Authorization is not required.) (Referral is not required.)
Routine foot care$35 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

$200 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)

Mental health services

Inpatient hospital – psychiatric$200 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)
Outpatient group therapy visit with a psychiatrist$40 copay (Authorization is not required.) (Referral is not required.)
Outpatient individual therapy visit with a psychiatrist$40 copay (Authorization is not required.) (Referral is not required.)
Outpatient group therapy visit$40 copay (Authorization is not required.) (Referral is not required.)
Outpatient individual therapy visit$40 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 Value (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

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