Gundersen Quartz Med Advantage Value (HMO) Medicare Advantage Plan H5262-004 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4450.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 875 beneficiaries
Gundersen Quartz Med Advantage Value (HMO) Introduction
Gundersen Quartz Med Advantage Value is a Medicare Advantage HMO plan offered by Quartz Medicare Advantage (HMO). It uses a Health Maintenance Organization (HMO) provider network and comes without prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $0.00 medical deductible, and $4450.00 in-network maximum out-of-pocket. CMS Plan ID H5262-004 identifies this plan.
Plan Benefits
Gundersen Quartz Med Advantage Value has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H5262-004.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $15 copay | Coming soon |
| Specialist | In-network: $50 copay | Coming soon |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay | Coming soon |
| Telehealth benefit | In-network: $0-$60 copay | Coming soon |
| Routine chiropractic | In-network: $15 copay | Coming soon |
| Fitness benefits | Coming soon | Coming soon |
| Health education | Not covered | Coming soon |
| Counseling services | In-network: $0 copay | Coming soon |
| Over-the-counter drug benefits | Not covered | Coming soon |
| Health transportation (non-emergency) | Coming soon | Coming soon |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $150 copay | Coming soon |
| Lab services | In-network: $10 copay | Coming soon |
| Outpatient x-rays | In-network: $10 copay | Coming soon |
| Diagnostic tests and procedures | In-network: $10 copay | Coming soon |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $150 copay | Coming soon |
| Worldwide emergency care | Coming soon | Coming soon |
| Urgent care | $60 copay | Coming soon |
| Inpatient hospital care | Tier 1 $225 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
Coming soon |
| Skilled Nursing Facility | Tier 1 $0 per day for days 1-20 $221 per day for days 21-100 |
Coming soon |
| Ground ambulance | In-network: $300 copay | Coming soon |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $40 copay | Coming soon |
| Outpatient group therapy | In-network: $40 copay | Coming soon |
| Inpatient psychiatric hospital care | Tier 1 $225 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
Coming soon |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $30 copay | Coming soon |
| Occupational therapy | In-network: $30 copay | Coming soon |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay | Coming soon |
| Durable medical equipment | In-network: 20% coinsurance | Coming soon |
| Prosthetics | In-network: 20% coinsurance | Coming soon |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance | Coming soon |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance | Coming soon |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay | Coming soon |
| Dental x-rays | In-network: $0 copay | Coming soon |
| Cleaning | In-network: $0 copay | Coming soon |
| Periodontics | In-network: $0 copay | Coming soon |
| Endodontics | In-network: $0 copay | Coming soon |
| Restorative services | In-network: $0 copay | Coming soon |
| Implant services | In-network: 50% coinsurance | Coming soon |
| Orthodontics | Not covered | Coming soon |
| Oral/Maxillofacial surgery | In-network: $0 copay | Coming soon |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay | Coming soon |
| Contact lenses | In-network: $0 copay | Coming soon |
| Eyeglass frames only | In-network: $0 copay | Coming soon |
| Eyeglass lenses only | In-network: $0 copay | Coming soon |
| Eyeglasses (frames & lenses) | In-network: $0 copay | Coming soon |
| Upgrades | In-network: $0 copay | Coming soon |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $35 copay | Coming soon |
| Fitting/evaluation | Not covered | Coming soon |
| Prescription hearing aids | In-network: $0 copay | Coming soon |
| OTC hearing aids | Not covered | Coming soon |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Coming soon |
| Home-based palliative care | Not covered | Coming soon |
| Personal emergency response system | Coming soon | Coming soon |
| Weight management programs | Not covered | Coming soon |
| Wigs for chemotherapy-related hair loss | Coming soon | Coming soon |
| Alternative therapies | Not covered | Coming soon |
| Massage therapy | In-network: $15 copay | Coming soon |
| Home/bathroom safety devices | Not covered | Coming soon |
Certain preventive services are covered 100% by Gundersen 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 Performance Ratings (Contract ID: H5262)
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 |
|---|---|
| 2027 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 |
Contact Information for Quartz Medicare Advantage (HMO)
- Website
- Quartz Medicare Advantage (HMO) Plan Page
- Providers
- Quartz Medicare Advantage (HMO) Providers Page
- Formulary
- Quartz Medicare Advantage (HMO) Formulary Page
- Pharmacy
- Quartz Medicare Advantage (HMO) Pharmacy Page
- New Member Health Plan Help
- (800)394-5566
- New Member Health Plan TTY
- (800)877-8973
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Gundersen Quartz Med Advantage Value (H5262-004-0) is available in the following locations:
Iowa Counties Served
Wisconsin Counties Served
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Gundersen Quartz Med Advantage Value (HMO)
How much does plan H5262-004 cost per month?
The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.
What is the annual out-of-pocket maximum (MOOP) for this plan?
The annual in-network MOOP is $4450.00 for 2027. After this limit is reached, covered in-network services are fully paid.
How many beneficiaries are enrolled in this plan?
CMS reports 875 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $0.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Quartz Medicare Advantage (HMO) (official source) | http://quartzbenefits.com/medicareadvantage | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Explore your Medicare coverage options | 25 May, 2025 |
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