Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) Medicare Advantage Plan H5262-021 • 2027 • Pepin County, WI
- Monthly Premium
- $42.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $5900.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $270.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Pepin County, WI
- Local Enrollment
- 0 beneficiaries in Pepin County
Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) Introduction
CMS Plan ID H5262-021 identifies Gundersen Quartz Med Advantage Core D (w/Rx), a Medicare Advantage HMO plan offered by Quartz Medicare Advantage (HMO). The plan uses a Health Maintenance Organization (HMO) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $42.00 monthly premium, $0.00 medical deductible, and $5900.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $270.00.
This plan is available to eligible beneficiaries who live in Pepin County, Wisconsin. CMS reports local enrollment of 0 beneficiaries for this plan in Pepin County. New members can contact the plan at (800)394-5566 (TTY (800)877-8973) for help and additional plan information.
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.
| Plan Detail | Gundersen Quartz Med Advantage Core D (w/Rx) | Gundersen Quartz Med Advantage Elite D (w/Rx) | Gundersen Quartz Med Advantage Value D (w/Rx) |
|---|---|---|---|
| CMS Plan ID | H5262-021-0 |
H5262-001-0 |
H5262-003-0 |
| Local Enrollment | 0 | 0 | 0 |
| Monthly Premium | $42.00 | $202.00 | $97.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $5,900.00 | $4,000.00 | $4,900.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $25 copay | $10 copay | $15 copay |
| Specialist | $60 copay | $45 copay | $50 copay |
| Part D Deductible | $270.00 | $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 | $40 copay | $25 copay | $35 copay |
Plan Benefits
Cost-sharing for Gundersen Quartz Med Advantage Core D (w/Rx) includes out-of-pocket expenses for covered healthcare services. The following tables provide a summary of typical in-network out-of-pocket costs for plan H5262-021.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5262-021-0 Cost Compare.
Office Visits
- Primary care
- In-network: $25 copay
- Specialist
- In-network: $60 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- Telehealth benefit
- In-network: $0-$60 copay
- Routine chiropractic
- In-network: $15 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: $275 copay
- Lab services
- In-network: $30 copay
- Outpatient x-rays
- In-network: $35 copay
- Diagnostic tests and procedures
- In-network: $30 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
$290 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 - Ground ambulance
- In-network: $300 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $50 copay
- Outpatient group therapy
- In-network: $50 copay
- Inpatient psychiatric hospital care
- Tier 1
$290 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: $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: $40 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: $25 copay
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by Gundersen Quartz Med Advantage Core D (w/Rx) as a Part B benefit.
Prescription Drug Coverage
Gundersen Quartz Med Advantage Core 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: | $35.00 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $35.00 |
| Low-Income Premium Subsidy: | $6.27 |
| Low-Income Premium Subsidy Paid by CMS: | $8.20 |
| Low-Income Subsidy Premium: | $26.80 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $270.00 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 Quartz Med Advantage Core 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 | 28% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
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.
| 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.
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 | Compare types of Medicare Advantage Plans | 25 May, 2025 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | 25 May, 2025 |
| Medicare.gov | Explore your Medicare coverage options | 25 May, 2025 |
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