Network Health Cares (PPO D-SNP) H5215-007 • 2027 • Ozaukee County, WI
- Monthly Premium
- $6.30Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Basic, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Ozaukee County, WI
- Local Enrollment
- 0 beneficiaries in Ozaukee County
Introduction
Network Health Cares is a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) offered by Network Health Medicare Advantage Plans. The plan uses a Preferred Provider Organization (PPO) provider network and includes Medicare Part D prescription drug coverage. For the 2027 plan year, it has a $6.30 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. CMS Plan ID H5215-007 identifies this plan. The 2027 Part D prescription drug deductible is $700.00.
This plan is available to eligible residents of Ozaukee County, Wisconsin. CMS reports 0 beneficiaries enrolled in this plan in Ozaukee County. For assistance with this plan, new members can call (800)983-7587 (TTY 711).
Eligibility
Network Health Cares is a Dual Eligible Special Needs Plan (D-SNP) designed for individuals enrolled in both Medicare and Medicaid.
- Special Needs Plan Type
- Dual-Eligible Special Needs Plan (D-SNP)
- Medicare Requirement
- Medicare Part A and Part B
- Special Needs Requirement
- Must qualify for Medicaid
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Compare Similar Plans in Ozaukee County
Compare this plan with the two most-enrolled PPO D-SNP plans available in Ozaukee County, Wisconsin. Enrollment is based on CMS local enrollment data.
| Plan Detail | Network Health Cares | HumanaChoice SNP-DE H5216-420 | UHC Dual Advantage WI-V2 |
|---|---|---|---|
| CMS Plan ID | H5215-007-0 |
H5216-420-0 |
H0294-027-0 |
| Local Enrollment | 0 | 65 | 20 |
| Monthly Premium | $6.30 | $0.00 | $6.30 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $9,850.00 | $9,850.00 | $9,850.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | 0% or 20% coinsurance | $0 copay | 0% or 0%-20% coinsurance |
| Specialist | 0% or 20% coinsurance | 0% or 20% coinsurance | 0% or 0%-20% coinsurance |
| Part D Deductible | $700.00 | $600.00 | $700.00 |
| 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 | $0 copay | $0 copay | $0 copay |
Plan Benefits
Network Health Cares 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 H5215-007.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5215-007-0 Cost Compare.
Office Visits
- Primary care
- In-network: 0% or 20% coinsurance
Out-of-network: 0% or 20% coinsurance - Specialist
- In-network: 0% or 20% coinsurance
Out-of-network: 0% or 20% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- Not covered
- Telehealth benefit
- In-network: 0% or 0%-20% coinsurance
- 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% or 20% coinsurance
Out-of-network: 0% or 20% coinsurance - Lab services
- In-network: 0% or 20% coinsurance
Out-of-network: 0% or 20% coinsurance - Outpatient x-rays
- In-network: 0% or 20% coinsurance
Out-of-network: 0% or 20% coinsurance - Diagnostic tests and procedures
- In-network: 0% or 20% coinsurance
Out-of-network: 0% or 20% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- 0% or 20% coinsurance
- Worldwide emergency care
- Coming soon
- Urgent care
- 0% or 20% coinsurance
- Inpatient hospital care
- In-network:
Tier 1
$0 per day for days 1-60
$0 or $434 per day for days 61-90
$0 or $868 per day for days 91-150
Out-of-network:
$0 per day for days 1-60
$0 or $434 per day for days 61-90
$0 or $868 per day for days 91-150 - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$0 or $217 per day for days 21-100
Out-of-network: - Ground ambulance
- In-network: 0% or 20% coinsurance
Out-of-network: 0% or 20% coinsurance
Mental Health Services
- Outpatient individual therapy
- In-network: 0% or 20% coinsurance
Out-of-network: 0% or 20% coinsurance - Outpatient group therapy
- In-network: 0% or 20% coinsurance
Out-of-network: 0% or 20% coinsurance - Inpatient psychiatric hospital care
- In-network:
Tier 1
$0 per day for days 1-60
$0 or $434 per day for days 61-90
$0 or $868 per day for days 91-150
Out-of-network:
$0 per day for days 1-60
$0 or $434 per day for days 61-90
$0 or $868 per day for days 91-150
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: 0% or 20% coinsurance
Out-of-network: 0% or 20% coinsurance - Occupational therapy
- In-network: 0% or 20% coinsurance
Out-of-network: 0% or 20% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: 0% or 20% coinsurance
Out-of-network: 0% or 20% coinsurance - Durable medical equipment
- In-network: 0% or 20% coinsurance
Out-of-network: 0% or 20% coinsurance - Prosthetics
- In-network: 0% or 20% coinsurance
Out-of-network: 0% or 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0% or 0%-20% coinsurance
Out-of-network: 0% or 0%-20% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0% or 0%-20% coinsurance
Out-of-network: 0% or 0%-20% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
Out-of-network: $0 copay - Dental x-rays
- In-network: $0 copay
Out-of-network: $0 copay - Cleaning
- In-network: $0 copay
Out-of-network: $0 copay - 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: 0%-50% coinsurance - Implant services
- In-network: $0 copay
Out-of-network: 50% coinsurance - Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: $0 copay
Out-of-network: 0%-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 Cares as a Part B benefit.
Prescription Drug Coverage
Network Health Cares 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.
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: | $6.30 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $6.30 |
| Low-Income Premium Subsidy: | $6.27 |
| Low-Income Premium Subsidy Paid by CMS: | $6.30 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Network Health Medicare Advantage Plans starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Network Health Cares may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | 25% coinsurance |
| Generic drugs | 25% coinsurance | 25% coinsurance |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H5215)
CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.
| 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 Medicare Advantage Plans
- Website
- Network Health Medicare Advantage Plans Plan Page
- Providers
- Network Health Medicare Advantage Plans Providers Page
- Formulary
- Network Health Medicare Advantage Plans Formulary Page
- Pharmacy
- Network Health Medicare Advantage Plans Pharmacy Page
- New Member Health Plan Help
- (800)983-7587
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (800)983-7587
- 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 |
|---|---|---|
| Network Health Medicare Advantage Plans (official source) | https://networkhealth.com/ | October 4, 2026 |
| CMS.gov | Dual Eligible Special Needs Plans (D-SNPs) | April 28, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | April 28, 2026 |
| Medicare.gov | Joining a plan | April 28, 2026 |
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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.