Cooperative Medicare Advantage (HMO) Medicare Advantage Plan H7598-004 • 2027 • Burnett County, WI
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $6700.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $275.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Burnett County, WI
- Local Enrollment
- 16 beneficiaries in Burnett County
Cooperative Medicare Advantage (HMO) Introduction
Cooperative Medicare Advantage is a Medicare Advantage HMO plan offered by Group Health Cooperative of Eau Claire. It uses a Health Maintenance Organization (HMO) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $0.00 medical deductible, and $6700.00 in-network maximum out-of-pocket. CMS Plan ID H7598-004 identifies this plan. The 2027 Part D prescription drug deductible is $275.00.
You must live in Burnett County, Wisconsin to enroll in this plan. CMS reports 16 beneficiaries enrolled in this plan in Burnett County. For assistance with this plan, new members can call (800)460-4641 (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 | Cooperative Medicare Advantage | Esteem Rx | Compass |
|---|---|---|---|
| CMS Plan ID | H7598-004-0 |
H5211-012-0 |
H5211-003-0 |
| Local Enrollment | 16 | 608 | 114 |
| Monthly Premium | $0.00 | $20.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $6,700.00 | $7,150.00 | $5,000.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $45 copay | $50 copay | $50 copay |
| Part D Deductible | $275.00 | $550.00 | Not Applicable |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0-$50 copay | $0-$50 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
Cooperative Medicare Advantage 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 H7598-004.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H7598-004-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $45 copay
Preventive and Wellness Services
- Annual wellness exam
- Not covered
- Telehealth benefit
- In-network: $0 copay
- Routine chiropractic
- In-network: $15 copay
- Fitness benefits
- Coming soon
- Health education
- Not covered
- 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: $150-$200 copay
- Lab services
- In-network: $20 copay
- Outpatient x-rays
- In-network: $50-$100 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
- $50 copay
- Inpatient hospital care
- Tier 1
$450 per day for days 1-6
$0 per day for days 7-90
$0 per stay - Skilled Nursing Facility
- Tier 1
$10 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: $45 copay
- Outpatient group therapy
- In-network: $45 copay
- Inpatient psychiatric hospital care
- Tier 1
$450 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $45 copay
- Occupational therapy
- In-network: $45 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- Durable medical equipment
- In-network: 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
- In-network: 50% coinsurance
- Endodontics
- In-network: 50% coinsurance
- Restorative services
- In-network: 50% coinsurance
- Implant services
- In-network: 50% coinsurance
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: 50% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- 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
- Not covered
- Prescription hearing aids
- In-network: $0 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
- Not covered
Certain preventive services are covered 100% by Cooperative Medicare Advantage as a Part B benefit.
Prescription Drug Coverage
Cooperative Medicare Advantage 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 $275.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Group Health Cooperative of Eau Claire starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Cooperative Medicare Advantage 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 | $15.00 copay | Coming soon |
| Preferred Brand | 19% coinsurance | Coming soon |
| Non-Preferred Drug | 35% coinsurance | Coming soon |
| Specialty Tier | 29% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H7598)
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 | Not enough data available |
| Managing Chronic (Long Term) Conditions | Not enough data available |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | Not enough data available |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Not enough data available |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing | Not enough data available |
Contact Information for Group Health Cooperative of Eau Claire
- Website
- Group Health Cooperative of Eau Claire Plan Page
- Providers
- Group Health Cooperative of Eau Claire Providers Page
- Formulary
- Group Health Cooperative of Eau Claire Formulary Page
- Pharmacy
- Group Health Cooperative of Eau Claire Pharmacy Page
- New Member Health Plan Help
- (800)460-4641
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (800)460-4641
- 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 |
|---|---|---|
| Group Health Cooperative of Eau Claire (official source) | http://www.group-health.com | 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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