2018 Network PlatinumSelect (PPO) H5215-8-0 in WI from Network Health | HealthPocket

Network PlatinumSelect (PPO)

$0/mo

Apply For This Plan

Zip Code53215
Applicant6/25/1984 Male
Coverage Start6/26/2019
Apply Now

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderNetwork Health
Plan IDH5215-8-0
Plan Year2018
CMS Rating
Plan TypePPO
Annual Deductible$395.00

What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2019. see plan

Why We Like This Plan
  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium
  • was the best selling plan in Milwaukee in 2019

Costs and Other Important Information

Plan Year2018
Optional Supplemental BenefitsYes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$6,700 In and Out-of-network $6,700 In-network
Other health plan deductibles?No
Health Plan Deductible$0
Monthly Drug Plan Premium$0.00
Monthly Health Plan Premium$0.00

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:
$450 for days 1 through 4
$0 for days 5 through 90
Out-of-Network:
$450 for days 1 through 4
$0 for days 5 and beyond
Outpatient hospital coverageIn-Network:
$395 per visit
Out-of-Network:
$395 per visit
Doctor visitsPrimary:
In-Network:
$25 per visit
Out-of-Network:
$25 per visit
Specialist:
In-Network:
$50 per visit
Out-of-Network:
$50 per visit
Preventive careIn-Network:
$0 copay
Out-of-Network:
$0 copay
Emergency care/Urgent careEmergency:
$80 per visit (always covered)
Urgent care:
$50 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:
$20-40
Out-of-Network:
$20-40
Lab services:
In-Network:
$20
Out-of-Network:
$20
Diagnostic radiology services (e.g., MRI):
In-Network:
$150
Out-of-Network:
$150
Outpatient x-rays:
In-Network:
$30
Out-of-Network:
$20-40
Mental health servicesIn-Network:
$395 for days 1 through 4
$0 for days 5 through 90
Out-of-Network:
$395 for days 1 through 4
$0 for days 5 through 190
Outpatient group therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
$40
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
$40
Outpatient group therapy visit:
In-Network:
$40
Out-of-Network:
$40
Outpatient individual therapy visit:
In-Network:
$40
Out-of-Network:
$40
Skilled Nursing FacilityIn-Network:
$0 for days 1 through 20
$167 for days 21 through 57
$0 for days 58 through 100
Out-of-Network:
$0 for days 1 through 20
$167 for days 21 through 57
$0 for days 58 through 100
Rehabilitation servicesOccupational therapy visit:
In-Network:
$40
Out-of-Network:
$40
Physical therapy and speech and language therapy visit:
In-Network:
$40
Out-of-Network:
$40
AmbulanceIn-Network:
$300
Out-of-Network:
$300
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:
$50
Out-of-Network:
$50
Routine foot care:
Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
20% per item
Out-of-Network:
20% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
20% per item
Out-of-Network:
20% per item
Diabetes supplies:
In-Network:
$10 per item
Out-of-Network:
$10 per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:
20%
Out-of-Network:
20%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
20%

Coverage Area for Network PlatinumSelect (PPO)

StateWisconsin
CountyMilwaukee

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$2 copay$4 copayNot offered
Tier 2: Non-Preferred Generic$8 copay$14 copayNot offered
Tier 3: Preferred Brand Name$42 copay$47 copayNot offered
Tier 4: Non-Preferred Brand Name$84 copay$91 copayNot offered
Tier 5: Specialty Tier25% coinsurance25% coinsuranceNot offered

90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$5 copay$10 copayNot offered
Tier 2: Non-Preferred Generic$20 copay$35 copayNot offered
Tier 3: Preferred Brand Name$105 copay$118 copayNot offered
Tier 4: Non-Preferred Brand Name$210 copay$228 copayNot offered
Tier 5: Specialty Tier

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate
Statin Use in Persons with DiabetesNot Rated

Physicians that accept Network PlatinumSelect (PPO) for Wisconsin

/
Please select the correct zip
Nancy, Nguyen
View All Details
Sahibzada, Latif
View All Details
Tyler, Steward
View All Details
Joshua, Neubauer
View All Details
Michael, Lischak
View All Details
Christopher, Adams
View All Details
Anwer, Dhala
View All Details
Jasbir, Sra
View All Details
Steven, Murphy
View All Details
Jessica, Kuester
View All Details
Moitreyee, Reddy
View All Details
Maher, Fattouh
View All Details
Yogendra, Bharat
View All Details
Hany, Nosir
View All Details
Thomas, Stauss
View All Details
Donald, Harvey
View All Details
Scott, Aschenbrener
View All Details
Denise, Sadler
View All Details
Marco, Araujo
View All Details
Gregg, Gaylord
View All Details
Jeremy, Scarlett
View All Details
Carol, Wood
View All Details
Jacqueline, Gerhart
View All Details
Kevin, Polglaze
View All Details
Nancy Nguyen, M.D.
View All Details
  • Phone Number
    (414) 672-1353
  • Office Locations
    2906 S 20th St
    Milwaukee, WI 53215
2906 S 20th St Milwaukee WI, 53215

get free advice

Speak With A Licensed Agent

Call (800) 931-6467

Learn More

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)