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Network Health Armor (PPO)

H5215 - 013 - 0
5 out of 5 stars (5 / 5)

Network Health Armor (PPO) is a Medicare Advantage Plan by Network Health Medicare Advantage Plans.

This page features plan details for 2025 Network Health Armor (PPO) H5215 – 013 – 0 available in East Central Wisconsin.

Locations

Network Health Armor (PPO) is offered in the following locations.

Brown County, Wisconsin
Calumet County, Wisconsin
Dodge County, Wisconsin

Click to see more locations

Plan Overview

Network Health Armor (PPO) offers the following coverage and cost-sharing.

Insurer:Network Health Medicare Advantage Plans
Health Plan Deductible:$0
MOOP:$4,900 In and Out-of-network
$4,900 In-network
Drugs Covered:No

Ready to sign up for Network Health Armor (PPO) ?

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

Network Health Armor (PPO) 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
$185.00 $0.00 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Network Health Armor (PPO) also provides the following benefits.

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

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – No Co pay (Limits Apply, Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply, Authorization Required)
  • Endodontics
    • In-Network: No Coins – No Co pay (Limits Apply, Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply, Authorization Required)
  • Implant Services
    • In-Network: No Coins – No Co pay (Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Authorization Required)
  • Maxillofacial Prosthetics
    • Out-of-Network: 50% Coins – No Copay (Limits Apply, Authorization Required)
  • Maxillofacial Prosthetics
    • In-Network: No Coins – No Co pay (Limits Apply, Authorization Required)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – No Co pay (Limits Apply, Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply, Authorization Required)
  • Periodontics
    • In-Network: No Coins – No Co pay (Limits Apply, Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply, Authorization Required)
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay (Limits Apply, Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply, Authorization Required)
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay (Limits Apply, Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply, Authorization Required)
  • Restorative Services
    • In-Network: No Coins – No Co pay (Limits Apply, Authorization Required)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply, Authorization Required)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay
  • Fluoride Treatment
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay
  • Other Diagnostic Dental Services
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Other Preventive Dental Services
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $40-125 copay (Authorization Required)
  • Diagnostic tests and procedures
    • Out-of-Network: $20-40 copay (Authorization Required)
  • Lab services
    • Out-of-Network: $0-20 copay (Authorization Required)
    • In-Network: $0-20 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $30 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: $40-125 copay (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $20-40 copay (Authorization Required)
  • Outpatient x-rays
    • Out-of-Network: $30 copay (Authorization Required)

Doctor visits

  • Primary
    • In-Network: $0 copay
  • Specialist
    • Out-of-Network: $40 copay per visit (Authorization Required)
  • Primary
    • Out-of-Network: $0 copay
  • Specialist
    • In-Network: $40 copay per visit (Authorization Required)

Emergency care/Urgent care

  • Emergency
    • $125 copay per visit (always covered)
  • Urgent care
    • $40 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $40 copay (Authorization Required)
    • Out-of-Network: $40 copay (Authorization Required)
  • Routine foot care
    • Not covered

Ground ambulance

    • In-Network: $300 copay
    • Out-of-Network: $300 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • Out-of-Network: $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • In-Network: $40 copay
  • Hearing aids
    • In-Network: $495-1,695 copay (Limits Apply)
  • Hearing aids OTC
    • Not covered
  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply)
  • Hearing aids
    • Out-of-Network: $495-1,695 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • Out-of-Network: $40 copay

Inpatient hospital coverage

    • In-Network: $295 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)
    • Out-of-Network: $295 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)

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

    • $4,900 In and Out-of-network
      $4,900 In-network

Medical equipment/supplies

  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 0-20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • In-Network: $0 copay (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • Out-of-Network: $0 copay (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 0-20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Chemotherapy
    • Out-of-Network: 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • Out-of-Network: 0-20% coinsurance (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • In-Network: $395 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $20 copay (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $20 copay (Authorization Required)
    • Out-of-Network: $20 copay (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: $20 copay (Authorization Required)
  • Outpatient group therapy visit
    • Out-of-Network: $20 copay (Authorization Required)
  • Outpatient individual therapy visit
    • Out-of-Network: $20 copay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $20 copay (Authorization Required)
    • Out-of-Network: $20 copay (Authorization Required)
  • Inpatient hospital – psychiatric
    • Out-of-Network: $395 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • Out-of-Network: $0-275 copay per visit (Authorization Required)
    • In-Network: $0-275 copay per visit (Authorization Required)

Preventive care

    • Out-of-Network: $0 copay
    • In-Network: $0 copay

Rehabilitation services

  • Occupational therapy visit
    • In-Network: $30 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: $30 copay (Authorization Required)
  • Occupational therapy visit
    • Out-of-Network: $30 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • In-Network: $30 copay (Authorization Required)

Skilled Nursing Facility

    • Out-of-Network: $0 per day for days 1 through 20
      $214 per day for days 21 through 45
      $0 per day for days 46 through 100 (Authorization Required)
    • In-Network: $0 per day for days 1 through 20
      $214 per day for days 21 through 45
      $0 per day for days 46 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Not covered
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Other
    • Not covered
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Upgrades
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • Not covered
  • Routine eye exam
    • Out-of-Network: $0 copay (Limits Apply)

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

    • Covered

Ready to sign up for Network Health Armor (PPO) ?

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

Need more information on Network Health Armor (PPO)? See 2025 Network Health Armor (PPO) at MedicareAdvantageRX.com.

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