Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) Medicare Advantage Plan H9834-003 • 2027
- Monthly Premium
- $93.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4900.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $225.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 1,429 beneficiaries
Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) Introduction
Gundersen MN Quartz Med Advantage Value D (w/Rx) is a Medicare Advantage HMO plan offered by Quartz Medicare Advantage (HMO). It uses a Health Maintenance Organization (HMO) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $93.00 monthly premium, $0.00 medical deductible, and $4900.00 in-network maximum out-of-pocket. CMS Plan ID H9834-003 identifies this plan. The 2027 Part D prescription drug deductible is $225.00.
Plan Benefits
Gundersen MN Quartz Med Advantage Value D (w/Rx) 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 H9834-003.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $15 copay | In-network: $15 copay |
| Specialist | In-network: $50 copay | In-network: $50 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay | In-network: $0 copay |
| Telehealth benefit | In-network: $0-$60 copay | In-network: $0-$60 copay |
| Routine chiropractic | In-network: $15 copay | In-network: $20 copay |
| Fitness benefits | Coming soon | Not covered |
| Health education | Not covered | Not covered |
| Counseling services | In-network: $0 copay | In-network: $0 copay |
| Over-the-counter drug benefits | Not covered | Not covered |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $200 copay | In-network: $100 copay |
| Lab services | In-network: $20 copay | In-network: $15 copay |
| Outpatient x-rays | In-network: $20 copay | In-network: $15 copay |
| Diagnostic tests and procedures | In-network: $20 copay | In-network: $15 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $130 copay | $150 copay |
| Worldwide emergency care | Coming soon | $150 copay |
| Urgent care | $50 copay | $60 copay |
| Inpatient hospital care | Tier 1 $275 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
Tier 1 $250 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 $221 per day for days 21-100 |
Tier 1 $0 per day for days 1-20 $215 per day for days 21-100 |
| Ground ambulance | In-network: $300 copay | In-network: $300 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $40 copay | In-network: $40 copay |
| Outpatient group therapy | In-network: $40 copay | In-network: $40 copay |
| Inpatient psychiatric hospital care | Tier 1 $275 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
Tier 1 $250 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $40 copay | In-network: $40 copay |
| Occupational therapy | In-network: $40 copay | In-network: $40 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay | In-network: $0 copay |
| Durable medical equipment | In-network: 20% coinsurance | In-network: 20% coinsurance |
| Prosthetics | In-network: 20% coinsurance | In-network: 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay | In-network: $0 copay |
| Dental x-rays | In-network: $0 copay | In-network: $0 copay |
| Cleaning | In-network: $0 copay | In-network: $0 copay |
| Periodontics | In-network: $0 copay | In-network: $0 copay |
| Endodontics | In-network: $0 copay | In-network: $0 copay |
| Restorative services | In-network: $0 copay | In-network: $0 copay |
| Implant services | In-network: 50% coinsurance | In-network: 50% coinsurance |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $0 copay | In-network: $0 copay |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay | In-network: $0 copay |
| Contact lenses | In-network: $0 copay | In-network: $0 copay |
| Eyeglass frames only | In-network: $0 copay | In-network: $0 copay |
| Eyeglass lenses only | In-network: $0 copay | In-network: $0 copay |
| Eyeglasses (frames & lenses) | In-network: $0 copay | In-network: $0 copay |
| Upgrades | In-network: $0 copay | In-network: $0 copay |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $35 copay | In-network: $35 copay |
| Fitting/evaluation | Not covered | Not covered |
| Prescription hearing aids | In-network: $0 copay | In-network: $0 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | In-network: $20 copay | In-network: $20 copay |
| Home/bathroom safety devices | Not covered | Not covered |
Certain preventive services are covered 100% by Gundersen MN Quartz Med Advantage Value D (w/Rx) as a Part B benefit.
Prescription Drug Coverage
Gundersen MN Quartz Med Advantage Value D (w/Rx) includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $86.00 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $86.00 |
| Low-Income Premium Subsidy: | $24.60 |
| Low-Income Premium Subsidy Paid by CMS: | $24.60 |
| Low-Income Subsidy Premium: | $61.40 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $225.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Quartz Medicare Advantage (HMO) starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Gundersen MN Quartz Med Advantage Value D (w/Rx) may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $10.00 copay | Coming soon |
| Preferred Brand | 20% coinsurance | Coming soon |
| Non-Preferred Drug | 35% coinsurance | Coming soon |
| Specialty Tier | 30% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H9834)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| 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
- New Member Part D Help
- (800)394-5566
- New Member Part D TTY Users
- (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 MN Quartz Med Advantage Value D (w/Rx) (H9834-003-0) is available in the following locations:
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO)
How much does plan H9834-003 cost per month?
The plan’s monthly premium is $93.00 for 2027. The Part B premium is not included.
What is the MOOP for Gundersen MN Quartz Med Advantage Value D (w/Rx) in 2027?
The 2027 in-network MOOP is $4900.00. Once this limit is reached, covered in-network costs are fully covered.
What is the CMS star rating for Gundersen MN Quartz Med Advantage Value D (w/Rx)?
The 2027 CMS star rating for Gundersen MN Quartz Med Advantage Value D (w/Rx) is ★0.0 out of 5.
How many beneficiaries are enrolled in this plan?
CMS reports 1,429 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $225.00.
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/medicareadv | 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 | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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