Medicare Plans

Aspirus Health Plan Medicare Advantage

You trust Aspirus for your care. Now you can trust Aspirus Health Plan for your Medicare coverage. We offer all the benefits you need without leaving the network you know.

Need help? Call 715-631-7437 (TTY users call 1-855-931-4855) 8 am – 5 pm, Monday – Friday.

YOUR MEDICARE ADVANTAGE PARTNER IN CENTRAL WISCONSIN

You want care for the whole you, from head to toe. Our Medicare Advantage plans help you get it, without breaking your budget.

Choose a $0 premium plan and pay a little more for care if you need it. Or choose our low premium plan and save on out-of-pocket costs when you need care.

Among the benefits you’ll enjoy:

  • Dental, hearing and vision coverage
  • Coverage anywhere in the U.S. when you see a Medicare provider
  • Lower costs through the Aspirus network

Extra benefits for your health and wellness

  • SilverSneakers® Fitness. Be healthy, feel stronger, and have fun with the SilverSneakers Fitness program, including a free fitness club membership at participating locations. 
  • Quit line for tobacco and nicotine. Get started on a tobacco- and nicotine-free life. Quit line coaches help you learn to live without tobacco or nicotine at no charge. 
  • Over-the-counter (OTC) allowance. Save on health items at participating stores with your OTC allowance. Use it to buy cough drops, first aid supplies, pain relievers and more.
  • An annual review of your prescriptions, over-the-counter medications and supplements with a specially trained Aspirus Health Plan pharmacist at no additional cost for members with prescription drug coverage.

Understanding Medicare

Learn the basics of Medicare, including the 4 parts of Medicare, what they cover, when to enroll, and how to enroll.

Learn the basics

Important plan documents

Is your doctor in-network?
Provider and Pharmacy directory
Primary Care Clinic List

Are your drugs covered?
Formulary (list of covered drugs)

Learn about our 2021 Plans
Summary of benefits

Essential Rx (PPO)

$0.00

2021 Monthly Premium

*You must continue to pay your Part B premium

Doctor visits

Primary: $0 copay
Specialist: $45 copay

Out-of-pocket maximum

In-network: $5,900
Out-of-network combined with in-network: $6,500

Preventive care

$0 copay for many services

Inpatient hospital

$350 copay per day (days 1–5); then
100% covered

Outpatient surgery/services
and observation stay

$395 copay

Emergency care (worldwide)

$90 copay

Dental coverage

Includes routine dental with optional coverage available

Lab services

$0 copay

Out-of-network coverage with any provider that accepts Medicare

30% of the cost of services

Over-the-counter (OTC) allowance

$50 semiannually

SilverSneakers® fitness program

Includes basic health
club membership

Medicare Part D prescription
drug coverage

Annual deductible:
Tier 1 & 2 = $0
Tiers 3–5 = $295
Copays based on drug tiers, as low as $3

Vision coverage

$0 copay for routine eye exam
$45 copay for diagnostic eye exam
$100 eyewear/contacts allowance

Shingrix vaccine

Copays shown at preferred pharmacy rates^

$3 copay

Hearing coverage

$0 copay for routine hearing exam
$45 copay for diagnostic hearing exam
$699 per Advanced Hearing Aid
$999 per Premium Hearing Aid

^Aspirus Health Plan preferred pharmacies offer lower cost sharing.

Elite Rx (PPO)

$79.00

2021 Monthly Premium

*You must continue to pay your Part B premium

Doctor visits

Primary: $0 copay
Specialist: $40 copay

Out-of-pocket maximum

In-network: $4,000
Out-of-network combined with in-network: $4,500

Preventive care

$0 copay for many services

Inpatient hospital

$300 copay per stay; then 100% covered

Outpatient surgery/services and observation stay

$295 copay

Emergency care (worldwide)

$90 copay

Dental coverage

Includes routine dental with optional coverage available

Lab services

$0 copay

Out-of-network coverage with any provider that accepts Medicare

30% of the cost of services

Over-the-counter (OTC) allowance

$50 semiannually

SilverSneakers® fitness program

Includes basic health
club membership

Medicare Part D prescription
drug coverage

Annual deductible:
Tier 1 & 2 = $0
Tiers 3–5 = $295
Copays based on drug tiers, as low as $2

Vision coverage

$0 copay for routine eye exam
$40 copay for diagnostic eye exam
$175 eyewear/contacts allowance

Shingrix vaccine

Copays shown at preferred pharmacy rates^

$2 copay

Hearing coverage

$0 copay for routine hearing exam
$40 copay for diagnostic hearing exam
$599 per Advanced Hearing Aid
$899 per Premium Hearing Aid

^Aspirus Health Plan preferred pharmacies offer lower cost sharing.

Elite (PPO)

$0.00

2021 Monthly Premium

*You must continue to pay your Part B premium

Doctor visits

Primary: $0 copay
Specialist: $40 copay

Out-of-pocket maximum

In-network: $4,000
Out-of-network combined with in-network: $4,500

Preventive care

$0 copay for many services

Inpatient hospital

$300 copay stay; then 100% covered

Outpatient surgery/services
and observation stay

$295 copay

Emergency care (worldwide)

$90 copay

Dental coverage

Includes routine dental with optional coverage available

Lab services

$0 copay

Out-of-network coverage with any provider that accepts Medicare

30% of the cost of services

Over-the-counter (OTC) allowance

$50 semiannually

SilverSneakers® fitness program

Includes basic health club membership

Medicare Part D prescription
drug coverage

Not covered

Vision coverage

$0 copay for routine eye exam
$40 copay for diagnostic eye exam
$175 eyewear/contacts allowance

Shingrix vaccine

Not covered

Hearing coverage

$0 copay for routine hearing exam
$40 copay for diagnostic hearing exam
$599 per Advanced Hearing Aid
$899 per Premium Hearing Aid

Additional Links and Documents

Aspirus Health Plan, Inc. is a PPO plan with a Medicare contract. Enrollment in Aspirus Health Plan, Inc. depends on contract renewal.

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10/2020