Cooperative Medicare Advantage (HMO)
Available to residents of Dunn County, WI for 2026. Contract H7598, plan 004, segment 0.
- ✉ Email a copy of the plan benefit details
- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Dunn County
- Plan website
- Browse the Cooperative Medicare Advantage (HMO) formulary
New for 2026. This plan has no 2025 predecessor in the CMS crosswalk.
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $6,000.00? |
| Drug deductible | $275.00Tier 1 and 2 exempt |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO? |
| Contract / plan | H7598-004-0 |
| Offered by | Group Health Cooperative of Eau Claire |
| Parent organization | Group Health Cooperative of Eau Claire |
| Formulary drugs | 3,508 |
| Formulary exception tier | 4? |
| Pharmacy search | www.group-health.com |
| Member services | (800)460-4641TTY (800)716-3231 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- —
Published per contract — every plan under contract H7598 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $35 copay |
| Other health care professional | $35 copay |
| Additional telehealth services | Not covered |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | $0 copay |
| Kidney disease education | $0 copay |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $20 copay(authorization required) |
| Lab services | $20 copay(authorization required) |
| Diagnostic radiology (e.g. MRI, CT) | $150–$200 copay(authorization required) |
| Therapeutic radiology | 20% coinsurance(authorization required) |
| Outpatient x-rays | $50–$100 copay(authorization required) |
| Emergency and urgent care | |
| Emergency room | $130 copay |
| Urgent care | $50 copay |
| Worldwide emergency coverage | $130 copay |
| Worldwide urgent care | $50 copay |
| Worldwide emergency transportation | $295 copay |
| Hospital care | |
| Inpatient hospital stay | $295 per day for days 1–6; $0 per day for days 7–90(authorization required) |
| Outpatient hospital services | $300 copay(authorization required) |
| Outpatient observation | $300 copay |
| Ambulatory surgical center | $225 copay(authorization required) |
| Outpatient blood services | $0 copay |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $218 per day for days 21–100(authorization required) |
| Home health care | $0 copay(authorization required) |
| Kidney dialysis | 20% coinsurance(authorization required) |
| Rehabilitation | |
| Occupational therapy | $35 copay(authorization required) |
| Physical therapy and speech-language therapy | $35 copay(authorization required) |
| Cardiac rehabilitation | $35 copay(authorization required) |
| Pulmonary rehabilitation | $35 copay(authorization required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $295 per day for days 1–6; $0 per day for days 7–90(authorization required) |
| Outpatient mental health, individual session | $35 copay |
| Outpatient mental health, group session | $35 copay |
| Psychiatrist, individual session | $35 copay |
| Psychiatrist, group session | $35 copay |
| Partial hospitalization | $55 copay(authorization required) |
| Intensive outpatient program | $55 copay(authorization required) |
| Outpatient substance use, individual session | $35 copay |
| Outpatient substance use, group session | $35 copay |
| Opioid treatment program | $35 copay |
| Ambulance and transportation | |
| Ground ambulance | $295 copay(authorization required) |
| Air ambulance | $295 copay(authorization required) |
| Transportation to plan-approved locations | $0 copay(limits apply) |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | $0 copay(authorization required) |
| Diabetic therapeutic shoes or inserts | $0 copay(authorization required) |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $15 copay |
| Routine chiropractic care | $15 copay |
| Acupuncture | Not covered |
| Foot exams and treatment (Medicare-covered) | $35 copay(authorization required) |
| Routine foot care | $35 copay(authorization required, limits apply) |
| Dental? | |
| Medicare-covered dental services | $35 copay(authorization required) |
| Oral exams | $0 copay(limits apply) |
| Cleanings | $0 copay(limits apply) |
| Fluoride treatment | $0 copay(limits apply) |
| Dental x-rays | $0 copay(limits apply) |
| Other diagnostic dental services | Not covered |
| Other preventive dental services | Not covered |
| Comprehensive dental plan limit | $1,000 plan limit every year |
| Restorative services (fillings, crowns) | $0 copay |
| Endodontics (root canals) | $0 copay |
| Periodontics (gum disease) | $0 copay |
| Dentures and other removable prosthodontics | $0 copay |
| Maxillofacial prosthetics | $0 copay |
| Implants | $0 copay |
| Bridges and other fixed prosthodontics | $0 copay |
| Oral and maxillofacial surgery | $0 copay |
| Orthodontics | Not covered |
| Adjunctive general services | $0 copay |
| Vision? | |
| Eye exam (Medicare-covered) | $35 copay |
| Routine eye exam | $0 copay(limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | $35 copay(limits apply) |
| Eyewear plan limit | $500 plan limit every year |
| Contact lenses | $0 copay(limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(limits apply) |
| Eyeglass lenses | Not covered |
| Eyeglass frames | Not covered |
| Eyewear upgrades | Not covered |
| Hearing? | |
| Hearing exam (Medicare-covered) | $35 copay |
| Routine hearing exam | $0 copay(limits apply) |
| Hearing aid fitting and evaluation | Not covered |
| Hearing aid plan limit | $2,000 plan limit every three years |
| Hearing aids (all types) | $0 copay(limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | 0%–20% coinsurance(authorization required) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required) |
| Other Part B drugs | 0%–20% coinsurance(authorization required) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | $55 allowance every three months |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | $0 copay |
| Health education | Not covered |
| Nutritional / dietary benefit | Not covered |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | Not covered |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $15.00 |
| Tier 3 | 19% |
| Tier 4 | 50% |
| Tier 5 | 29% |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $15.00 | $15.00 | n/a | $45.00 | $45.00 | $45.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $15.00 | $15.00 | n/a | $45.00 | $45.00 | $45.00 |
| Tier 3: Preferred Brand | 19% | 19% | n/a | 19% | 19% | 19% |
| Tier 4: Non-Preferred Drug | 50% | 50% | n/a | 50% | 50% | 50% |
| Tier 5: Specialty Tier | 29% | 29% | n/a | n/a | n/a | n/a |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 49 other WI counties
- Adams
- Ashland
- Barron
- Bayfield
- Buffalo
- Burnett
- Chippewa
- Clark
- Columbia
- Crawford
- Douglas
- Eau Claire
- Florence
- Forest
- Grant
- Green
- Iowa
- Iron
- Jackson
- Juneau
- La Crosse
- Lafayette
- Langlade
- Lincoln
- Marathon
- Marquette
- Menominee
- Monroe
- Oconto
- Oneida
- Pepin
- Pierce
- Polk
- Portage
- Price
- Richland
- Rusk
- St. Croix
- Sauk
- Sawyer
- Shawano
- Taylor
- Trempealeau
- Vernon
- Vilas
- Washburn
- Waupaca
- Waushara
- Wood
Benefits in plain text
Cooperative Medicare Advantage (HMO) (H7598-004-0) is a 2026 HMO Medicare Advantage plan offered by Group Health Cooperative of Eau Claire, available to residents of Dunn County, WI.
The monthly premium is $0.00 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $6,000.00.
The drug deductible is $275.00. Tier 1 and 2 exempt.
The plan's formulary lists 3,508 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $15.00; tier 3: 19%; tier 4: 50%; tier 5: 29%.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.