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

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)