Gundersen MN Quartz Med Advantage Value (HMO)
Medicare Advantage Plan H9834-004 • 2026 • Fillmore County, MN
Gundersen MN Quartz Med Advantage Value (HMO) Medicare Advantage Plan H9834-004 • 2026 • Fillmore County, MN
This Medicare Advantage HMO plan, identified by CMS Plan ID H9834-004, is offered by Quartz Medicare Advantage (HMO) for the 2026 plan year. The plan uses a Health Maintenance Organization (HMO) provider network and comes without prescription coverage (Part D ).
Gundersen MN Quartz Med Advantage Value Overview
Plan Overview for H9834-004-0 |
|
|---|---|
| CMS Plan ID: | H9834-004-0 |
| Plan Type: | HMO |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $4200.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Not Included |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Fillmore County, MN |
| Enrollment (Nationwide) | 106 beneficiaries |
| Enrollment (CMS – Local) | 31 beneficiaries in Fillmore County |
| Provided By: | Quartz Medicare Advantage (HMO) |
Plan Overview for Gundersen MN Quartz Med Advantage Value
This Medicare Advantage Health Maintenance Organization (HMO) plan provides Medicare Part A and Part B coverage through a network of participating providers. The monthly premium is $0.00, and services are generally covered when received from in-network providers, except in emergency situations.
Primary care visits have a $15 copay, specialist visits come with a $50 copay, lab services cost {lab_services_cost}, urgent care services carry a $60 copay, and ambulance transportation is $300 copay. These costs apply toward the annual out-of-pocket maximum (MOOP) of $4200.00. After this limit is reached, in-network services are fully covered for the remainder of the year.
This plan is listed by CMS under Plan ID {title_plan_id}. Cost-sharing details for key services are provided below.
Cost-Sharing Overview
Gundersen MN Quartz Med Advantage Value includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The table below outlines the most common in-network out-of-pocket costs associated with plan H9834-004.
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $15 copay |
| Specialist: | In-network: $50 copay |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0-$60 copay |
| Routine chiropractic: | In-network: $15 copay |
| Fitness benefits: | Not covered |
| Health education: | Not covered |
| Counseling services: | In-network: $0 copay |
| Over-the-counter drug benefits: | Not covered |
| Health transportation (non-emergency): | Not covered |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $100 copay |
| Lab services: | In-network: $10 copay |
| Outpatient x-rays: | In-network: $10 copay |
| Diagnostic tests and procedures: | In-network: $10 copay |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $150 copay |
| Worldwide emergency care: | $150 copay |
| Urgent care: | $60 copay |
| Inpatient hospital care: | Tier 1 | $225 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay |
| Skilled Nursing Facility: | Tier 1 | $0 per day for days 1-20 | $215 per day for days 21-100 |
| Ground ambulance: | In-network: $300 copay |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $40 copay |
| Outpatient group therapy: | In-network: $40 copay |
| Inpatient psychiatric hospital care: | Tier 1 | $225 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $30 copay |
| Occupational therapy: | In-network: $30 copay |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay |
| Durable medical equipment: | In-network: 20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay |
| Dental x-rays: | In-network: $0 copay |
| Cleaning: | In-network: $0 copay |
| Periodontics: | In-network: $0 copay |
| Endodontics: | In-network: $0 copay |
| Restorative services: | In-network: $0 copay |
| Implant services: | In-network: 50% coinsurance |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $0 copay |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay |
| Contact lenses: | In-network: $0 copay |
| Eyeglass frames only: | In-network: $0 copay |
| Eyeglass lenses only: | In-network: $0 copay |
| Eyeglasses (frames & lenses): | In-network: $0 copay |
| Upgrades: | In-network: $0 copay |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $35 copay |
| Fitting/evaluation: | Not covered |
| Prescription hearing aids: | In-network: $0 copay |
| OTC hearing aids: | Not covered |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | In-network: $15 copay |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Gundersen MN Quartz Med Advantage Value as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Ratings
Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.
| CMS Measure | Star Rating |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
What is the monthly premium for Gundersen MN Quartz Med Advantage Value (HMO)?
For 2026, the monthly premium is $0.00. Medicare Part B premiums apply in addition to this amount.
What is the MOOP for Gundersen MN Quartz Med Advantage Value in 2026?
For 2026, the in-network maximum out-of-pocket is $4200.00. The plan pays 100% of covered in-network services beyond this amount.
What is the total enrollment for plan H9834-004?
CMS reports 106 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2026?
The plan’s Part D deductible is $0.00, applied to covered prescription drug costs.
Contact Information for Quartz Medicare Advantage (HMO)
| Contact Type | Details |
|---|---|
| Website: | Quartz Medicare Advantage (HMO) Plan Page |
| New Members: | 1-800-394-5566 |
| Existing Members: | 1-800-394-5566 |
| Plan Address: | 2650 Novation Parkway | Fitchburg, WI 53713 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation..
- Quartz Medicare Advantage (HMO) (official source), http://quartzbenefits.com/medicareadvantage — Last accessed October 13, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans" — Last accessed 25 May, 2025
- AARP.org, "The Big Choice: Original Medicare vs. Medicare Advantage" — Last accessed 25 May, 2025
- Medicare.gov, "Your coverage options" — Last accessed 25 May, 2025
MedicarePlans.com is an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Provenance documentation for this data is maintained under the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.