Network Health Bravo (PPO) Medicare Advantage Plan H5215-014 • 2027 • Kenosha County, WI
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4500.00In-network
- Part B Giveback
- −$15.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Kenosha County, WI
- Local Enrollment
- 19 beneficiaries in Kenosha County
Network Health Bravo (PPO) Introduction
CMS Plan ID H5215-014 identifies Network Health Bravo, a Medicare Advantage PPO plan offered by Network Health. The plan uses a Preferred Provider Organization (PPO) provider network and comes without prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $0.00 medical deductible, and $4500.00 in-network maximum out-of-pocket.
This plan is available to eligible beneficiaries who live in Kenosha County, Wisconsin. CMS reports local enrollment of 19 beneficiaries for this plan in Kenosha County. New members can contact the plan at (800)983-7587 (TTY 711) for help and additional plan information.
Compare Similar Plans in Kenosha County
Compare this plan with the two most-enrolled PPO plans available in Kenosha County, Wisconsin. Enrollment is based on CMS local enrollment data.
| Plan Detail | Network Health Bravo | Aetna Medicare Signature | Network Health Anywhere |
|---|---|---|---|
| CMS Plan ID | H5215-014-0 |
H5521-195-0 |
H5215-010-0 |
| Local Enrollment | 19 | 1,041 | 976 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $500 |
| Maximum Out-of-Pocket | $4,500.00 | $5,500.00 | $4,500.00 |
| Part B Giveback | −$15.00 reduction | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $40 copay | $40 copay | $45 copay |
| Part D Deductible | Not Applicable | $700.00 | $320.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $10 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
Network Health Bravo 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 H5215-014.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5215-014-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: $30 copay - Specialist
- In-network: $40 copay
Out-of-network: $75 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: $15 copay - Telehealth benefit
- In-network: $0-$40 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
Out-of-network: 90% coinsurance - Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0-$200 copay
Out-of-network: $50-$250 copay - Lab services
- In-network: $0-$20 copay
Out-of-network: $30 copay - Outpatient x-rays
- In-network: $35 copay
Out-of-network: $40 copay - Diagnostic tests and procedures
- In-network: $20 copay
Out-of-network: $30-$50 copay
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $45 copay
- Inpatient hospital care
- In-network:
Tier 1
$295 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
$550 per day for days 1-6
$0 per day for days 7-90
$0 per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-45
$0 per day for days 46-100
Out-of-network:
$221 per day for days 1-45
$0 per day for days 46-100
$0 per stay - Ground ambulance
- In-network: $300 copay
Out-of-network: $300 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $20 copay
Out-of-network: $20 copay - Outpatient group therapy
- In-network: $20 copay
Out-of-network: $20 copay - Inpatient psychiatric hospital care
- In-network:
Tier 1
$295 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
$550 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: $30 copay
Out-of-network: $75 copay - Occupational therapy
- In-network: $30 copay
Out-of-network: $75 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Durable medical equipment
- In-network: 0%-20% coinsurance
Out-of-network: 25% coinsurance - Prosthetics
- In-network: 20% coinsurance
Out-of-network: 25% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
Out-of-network: 50% coinsurance - Dental x-rays
- In-network: $0 copay
Out-of-network: 50% coinsurance - Cleaning
- In-network: $0 copay
Out-of-network: 50% coinsurance - Periodontics
- In-network: $0 copay
Out-of-network: 50% coinsurance - Endodontics
- In-network: $0 copay
Out-of-network: 50% coinsurance - Restorative services
- In-network: $0 copay
Out-of-network: 50% coinsurance - Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: $0 copay
Out-of-network: 50% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
Out-of-network: $0 copay - Contact lenses
- In-network: $0 copay
Out-of-network: $0 copay - Eyeglass frames only
- Not covered
- Eyeglass lenses only
- Not covered
- Eyeglasses (frames & lenses)
- In-network: $0 copay
Out-of-network: $0 copay - Upgrades
- In-network: $0 copay
Out-of-network: $0 copay
Hearing Services
- Hearing exam
- In-network: $0 copay
Out-of-network: 90% coinsurance - Fitting/evaluation
- In-network: $0 copay
Out-of-network: 90% coinsurance - Prescription hearing aids
- In-network: $495-$1695 copay
Out-of-network: 90% coinsurance - 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 Network Health Bravo 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: H5215)
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 Network Health
- Website
- Network Health Plan Page
- Providers
- Network Health Providers Page
- Formulary
- Network Health Formulary Page
- Pharmacy
- Network Health Pharmacy Page
- New Member Health Plan Help
- (800)983-7587
- New Member Health Plan TTY
- 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 |
|---|---|---|
| Network Health (official source) | http://networkhealth.com/ | October 4, 2026 |
| Medicare.gov | Compare types of 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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Data provenance is documented in accordance with 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.