Medicare Plans

Open Medicare Plan Data.

Gundersen Quartz Med Advantage Elite (HMO) Medicare Advantage Plan H5262-005 • 2027 • Pepin County, WI

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$4000.00In-network
Part B Giveback
Not offered
Prescription Coverage
Not Included
Additional Benefits
Dental, Vision, Hearing
Service Area
Pepin County, WI
Local Enrollment
0 beneficiaries in Pepin County
Last update:

Gundersen Quartz Med Advantage Elite (HMO) Introduction

Gundersen Quartz Med Advantage Elite 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 $4000.00 in-network maximum out-of-pocket. CMS Plan ID H5262-005 identifies this plan.

You must live in Pepin County, Wisconsin to enroll in this plan. CMS reports 0 beneficiaries enrolled in this plan in Pepin County. For assistance with this plan, new members can call (800)394-5566 (TTY (800)877-8973).

Compare Similar Plans in Pepin County

Compare this plan with the two most-enrolled HMO plans available in Pepin County, Wisconsin. Enrollment is based on CMS local enrollment data.

HMO plan comparison for Pepin County, Wisconsin
Plan Detail Gundersen Quartz Med Advantage Elite Gundersen Quartz Med Advantage Elite D (w/Rx) Gundersen Quartz Med Advantage Value D (w/Rx)
CMS Plan ID H5262-005-0 H5262-001-0 H5262-003-0
Local Enrollment 0 0 0
Monthly Premium $0.00 $202.00 $97.00
Medical Deductible $0.00 $0.00 $0.00
Maximum Out-of-Pocket $4,000.00 $4,000.00 $4,900.00
Part B Giveback Not offered Not offered Not offered
Primary Care $10 copay $10 copay $15 copay
Specialist $45 copay $45 copay $50 copay
Part D Deductible Not Applicable $200.00 $225.00
CMS Star Rating Not yet rated Not yet rated Not yet rated
Dental $0 copay $0 copay $0 copay
Vision $0 copay $0 copay $0 copay
Hearing $25 copay $25 copay $35 copay

Plan Benefits

Gundersen Quartz Med Advantage Elite 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 H5262-005.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5262-005-0 Cost Compare.

Office Visits

Primary care
In-network: $10 copay
Specialist
In-network: $45 copay

Preventive and Wellness Services

Annual wellness exam
In-network: $0 copay
Telehealth benefit
In-network: $0-$50 copay
Routine chiropractic
In-network: $10 copay
Fitness benefits
Coming soon
Health education
Not covered
Counseling services
In-network: $0 copay
Over-the-counter drug benefits
Not covered
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $100 copay
Lab services
In-network: $10 copay
Outpatient x-rays
In-network: $10 copay
Diagnostic tests and procedures
In-network: $10 copay

Emergency and Urgent Care Services

Emergency room care
$150 copay
Worldwide emergency care
Coming soon
Urgent care
$50 copay
Inpatient hospital care
Tier 1
$300 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: $300 copay

Mental Health Services

Outpatient individual therapy
In-network: $35 copay
Outpatient group therapy
In-network: $35 copay
Inpatient psychiatric hospital care
Tier 1
$300 per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $15 copay
Occupational therapy
In-network: $15 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: $0 copay
Endodontics
In-network: $0 copay
Restorative services
In-network: $0 copay
Implant services
In-network: 50% coinsurance
Orthodontics
Not covered
Oral/Maxillofacial surgery
In-network: $0 copay

Vision Services

Routine eye exam
In-network: $0 copay
Contact lenses
In-network: $0 copay
Eyeglass frames only
In-network: $0 copay
Eyeglass lenses only
In-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Upgrades
In-network: $0 copay

Hearing Services

Hearing exam
In-network: $25 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
In-network: $0 copay
Home/bathroom safety devices
Not covered

Certain preventive services are covered 100% by Gundersen Quartz Med Advantage Elite 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.

2027 Medicare Star Ratings for Contract H5262
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.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
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.

Official plan information and secondary Medicare references.
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 Explore your Medicare coverage options 25 May, 2025

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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.