Esteem Rx (HMO) Medicare Advantage Plan H5211-012 • 2027 • Burnett County, WI
- Monthly Premium
- $20.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $7150.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $550.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Burnett County, WI
- Local Enrollment
- 608 beneficiaries in Burnett County
Esteem Rx (HMO) Introduction
Esteem Rx is a Medicare Advantage HMO plan offered by Security Health Plan of Wisconsin, Inc.. It uses a Health Maintenance Organization (HMO) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $20.00 monthly premium, $0.00 medical deductible, and $7150.00 in-network maximum out-of-pocket. CMS Plan ID H5211-012 identifies this plan. The 2027 Part D prescription drug deductible is $550.00.
You must live in Burnett County, Wisconsin to enroll in this plan. CMS reports 608 beneficiaries enrolled in this plan in Burnett County. For assistance with this plan, new members can call (866)335-0482 (TTY 711).
Compare Similar Plans in Burnett County
Compare this plan with the two most-enrolled HMO plans available in Burnett County, Wisconsin. Enrollment is based on CMS local enrollment data.
| Plan Detail | Esteem Rx | Compass | Cooperative Medicare Advantage |
|---|---|---|---|
| CMS Plan ID | H5211-012-0 |
H5211-003-0 |
H7598-004-0 |
| Local Enrollment | 608 | 114 | 16 |
| Monthly Premium | $20.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $7,150.00 | $5,000.00 | $6,700.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $50 copay | $50 copay | $45 copay |
| Part D Deductible | $550.00 | Not Applicable | $275.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0-$50 copay | $0-$50 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
Esteem 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 H5211-012.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5211-012-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $50 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- Telehealth benefit
- In-network: $0-$300 copay, 0%-20% coinsurance
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- In-network: $0 copay
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0-$250 copay
- Lab services
- In-network: $10 copay
- Outpatient x-rays
- In-network: $20 copay
- Diagnostic tests and procedures
- In-network: $20 copay
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $0-$50 copay
- Inpatient hospital care
- Tier 1
$400 per day for days 1-4
$0 per day for days 5-90
$0 per stay - Skilled Nursing Facility
- Tier 1
$0 per day for days 1-20
$221 per day for days 21-100 - Ground ambulance
- In-network: $295 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $50 copay
- Outpatient group therapy
- In-network: $50 copay
- Inpatient psychiatric hospital care
- Tier 1
$400 per day for days 1-4
$0 per day for days 5-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $40 copay
- Occupational therapy
- In-network: $40 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- Durable medical equipment
- In-network: 0%-20% coinsurance
- Prosthetics
- In-network: 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- Not covered
- Endodontics
- Not covered
- Restorative services
- Not covered
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- Not covered
Vision Services
- Routine eye exam
- In-network: $0-$50 copay
- Contact lenses
- Not covered
- Eyeglass frames only
- Not covered
- Eyeglass lenses only
- Not covered
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $499-$999 copay
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- In-network: 20% coinsurance
Certain preventive services are covered 100% by Esteem Rx as a Part B benefit.
Prescription Drug Coverage
Esteem 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: | $0.00 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $6.27 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $550.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Security Health Plan of Wisconsin, Inc. starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Esteem 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 | $8.00 copay | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 30% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H5211)
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 Security Health Plan of Wisconsin, Inc.
- Website
- Security Health Plan of Wisconsin, Inc. Plan Page
- Providers
- Security Health Plan of Wisconsin, Inc. Providers Page
- Formulary
- Security Health Plan of Wisconsin, Inc. Formulary Page
- Pharmacy
- Security Health Plan of Wisconsin, Inc. Pharmacy Page
- New Member Health Plan Help
- (866)335-0482
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (866)335-0482
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
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 |
|---|---|---|
| Security Health Plan of Wisconsin, Inc. (official source) | http://www.securityhealth.org/medicar | 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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