UW Health Quartz Med Advantage Value (HMO)
H5262 - 009 - 0
(4.5 / 5)
UW Health Quartz Med Advantage Value (HMO) is a Medicare Advantage 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 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 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.
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 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 | $ |
- 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.
| $0 |
| In-network | No |
| $4,600 In-network |
| Yes |
| In-network | Yes, contact plan for further details |
| $0-400 copay per visit (Authorization is required.) (Referral is not required.) |
| Primary | $10 copay per visit (Not applicable.) (Not applicable.) |
| Specialist | $45 copay per visit (Authorization is not required.) (Referral is not required.) |
| $0 copay (Authorization is not required.) (Referral is not required.) |
| Emergency | $120 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $45 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| 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 exam | $25 copay (Authorization is not required.) (Referral is not required.) |
| Fitting/evaluation | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Hearing aids | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| 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.) |
| 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.) |
| 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.) |
| 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.) |
| $275 copay (Not applicable.) (Not applicable.) |
| $0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| 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.) |
| 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.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Part B Insulin drugs | $35 copay (Authorization is required.) (Not applicable.) |
| $200 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.) |
| 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.) |
| $0 per day for days 1 through 20 $170 per day for days 21 through 100 (Authorization is required.) (Referral is not required.) |
| Monthly Premium | $36.00 |
| Deductible | nan |
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.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Table of Contents
Need more information on UW Health Quartz Med Advantage Value (HMO)? See 2025 UW Health Quartz Med Advantage Value (HMO) at MedicareAdvantageRX.com.
Get Help Enrolling
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SMID: MULTIPLAN_HCIHNDOGMED01PY25_M
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