Medicare Counseling: Dual Eligible Special Need Plans (D-SNP) Plan - NetworkCares
Check what other D-SNPs are available in your county and what Medicaid plans they accept. (Excel)
Network Health Cares (PPO D-SNP, H5215-007)
For calendar year 2024
Contact information
Phone: 800-983-7587
TTY: 800-947-3529
Website: networkhealth.com
Eligibility
Who can get this plan
People with:
- Full benefit Medicaid
- The following Medicare Savings Programs:
- Qualified Medicare Beneficiary (QMB)
- Specified Low Income Beneficiary (SLMB)
- Qualified Individual (called SLMB+ in Wisconsin)
- Qualified Disabled Working Individual (QDWI)
Service area
- Brown
- Calumet
- Dodge
- Fond du Lac
- Green Lake
- Kewaunee
- Manitowoc
- Marquette
- Oconto
- Outagamie
- Portage
- Shawano
- Sheboygan
- Waupaca
- Waushara
- Winnebago
Star rating
5 out of 5 stars
Coverage
Check if your doctors are in-network: Find a doctor
Check if your prescription drugs are covered: Look up medications
Costs
If you are eligible for Medicare cost-sharing assistance through full Medicaid, you may pay $0 for benefits that state 0%-20% of the cost.
Doctor visit: 0-20%
Hospitalization:
Days 1-60: $0-1,632 deductible
Days 61-90: $0-408 per day
Days 91 and beyond: $0-816 per day
This plan covers 60 lifetime reserve days.
Skilled nursing facility:
Days 1-20: $0 per day
Days 21-100: $0-204 per day
Emergency department: 0-20%, up to $95
Extra benefits
Details: Summary of Benefits (PDF)
Basic dental:
- $0 cleaning, twice a year
- $0 dental X-ray(s): bitewing one per year, full mouth one every 5 years
- $0 oral exam, twice a year
- $0 basic restorative services
Extra dental:
- $0 for major services received at in-network providers (endodontics/ periodontics/extractions, prosthodontics, other oral/ maxillofacial surgery, other services)
- 50% of the cost for major services (endodontics/ periodontics/extractions, prosthodontics, other oral/ maxillofacial surgery, other services) received at out-of-network providers
$3,000 annual maximum
Vision:
- $0 annual routine vision exam
- $400 allowance in-network or $400 reimbursement out-of-network for additional eyewear
Hearing:
- $0 routine hearing exam in-network; $40 routine hearing exam out-of-network
- Maximum two hearing aids per year at $495-$1,695 per device; hearing aids must be purchased through TruHearing
Wellness programs: SilverSneakers
Other:
- Meal delivery: 28 home delivered meals following a qualified hospital observation stay, inpatient hospital stay or skilled nursing facility stay
- Fresh produce or pantry boxes: six boxes annually for members diagnosed with diabetes, congestive heart failure or obesity
- Over-the-counter coverage: $175 per quarter
- In-home support: 60 hours annually of in-home support for assistance with tasks such as light housework, technology help or transportation
- Non-emergency transportation: 36 one-way trips (members with ESRD may get up to an additional 24 one-way trips)
- $50 reward for completion of the health risk assessment
How to enroll
You can only enroll during a Medicare enrollment period; learn more at Medicare.gov.
Enrollment into this plan will automatically disenroll you from your current Medicare Advantage or Part D plan.
There are multiple ways to enroll:
- Call the plan at 800-983-7587
- Medicare.gov
- 1-800-MEDICARE
- Contact the State Health Insurance Assistance Program (SHIP)