HealthPartners Cedar (PPO)
Available to residents of Door County, WI for 2027. Contract H6309, plan 002, 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 Door County
- Plan website
- Browse the HealthPartners Cedar (PPO) formulary
2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.
Renewed for 2027. CMS carries this plan forward from 2026. Every WI plan’s 2026–2027 changes →
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) | $50.00 a month?You must continue to pay your Medicare Part B premium. |
| In-network out-of-pocket maximum | $9,850.00? |
| In- and out-of-network out-of-pocket maximum | $14,800.00 |
| Drug deductible | $700.00Tier 1 and 2 exempt |
| Drug out-of-pocket threshold | $2,400.00 |
| Plan type | PPO? |
| Contract / plan | H6309-002-0 |
| Offered by | HealthPartners |
| Parent organization | HealthPartners, Inc. |
| Formulary tiers | 5 |
| Formulary exception tier | 4? |
| Pharmacy search | healthpartners.com/MedicarePharm |
| Member services | (833)256-7046TTY 711 |
| CMS-accepted enrolment cap | 1,150 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- —
Published per contract — every plan under contract H6309 shares this rating.
Plan health benefits
| Service | In-network | Out-of-network? |
|---|---|---|
| Doctor visits | ||
| Primary care doctor | $0 copay | $0 copay |
| Specialist | $0–$60 copay | $0–$60 copay |
| Other health care professional | $0–$60 copay | $0–$60 copay |
| Additional telehealth services | Not covered | — |
| Preventive care | ||
| Medicare-covered preventive services | $0 copay | $0 copay |
| Annual physical exam | $0 copay | $0 copay |
| Kidney disease education | $0 copay | $0 copay |
| Glaucoma screening | $0 copay | $0 copay |
| Diabetes self-management training | $0 copay | $0 copay |
| Diagnostic tests, labs and imaging | ||
| Diagnostic tests and procedures | $100 copay(authorization required) | $100 copay |
| Lab services | 10% coinsurance(authorization required) | 10% coinsurance |
| Diagnostic radiology (e.g. MRI, CT) | $0–$500 copay(authorization required) | $0–$500 copay |
| Therapeutic radiology | 20% coinsurance(authorization required) | 20% coinsurance |
| Outpatient x-rays | $125 copay(authorization required) | $125 copay |
| Emergency and urgent care | ||
| Emergency room | $115 copay | — |
| Urgent care | $40 copay | — |
| Worldwide emergency coverage | $115 copay | — |
| Worldwide urgent care | $40 copay | — |
| Worldwide emergency transportation | $300 copay | — |
| Hospital care | ||
| Inpatient hospital stay | $600 per day for days 1–4; $0 per day for days 5–90(authorization required) | $600 per day for days 1–4; $0 per day for days 5–90 |
| Outpatient hospital services | $600 copay(authorization required) | $600 copay |
| Outpatient observation | $550 copay | $550 copay |
| Ambulatory surgical center | $500 copay(authorization required) | $500 copay |
| Outpatient blood services | $0 copay | $0 copay |
| Skilled nursing and home health | ||
| Skilled nursing facility | $0 per day for days 1–20; $221 per day for days 21–100(authorization required) | $0 per day for days 1–20; $221 per day for days 21–100 |
| Home health care | $0 copay(authorization required) | $0 copay |
| Kidney dialysis | 20% coinsurance | 20% coinsurance |
| Rehabilitation | ||
| Occupational therapy | $35 copay | $35 copay |
| Physical therapy and speech-language therapy | $35 copay | $35 copay |
| Cardiac rehabilitation | $30 copay | $30 copay |
| Pulmonary rehabilitation | $25 copay | $25 copay |
| Mental health and substance use | ||
| Inpatient psychiatric hospital stay | $520 per day for days 1–4; $0 per day for days 5–90 | $520 per day for days 1–4; $0 per day for days 5–90 |
| Outpatient mental health, individual session | $50 copay | $50 copay |
| Outpatient mental health, group session | $50 copay | $50 copay |
| Psychiatrist, individual session | $50 copay | $50 copay |
| Psychiatrist, group session | $50 copay | $50 copay |
| Partial hospitalization | $55 copay | $55 copay |
| Intensive outpatient program | $55 copay | $55 copay |
| Outpatient substance use, individual session | $50 copay | $50 copay |
| Outpatient substance use, group session | $50 copay | $50 copay |
| Opioid treatment program | $0 copay | $0 copay |
| Ambulance and transportation | ||
| Ground ambulance | $300 copay(authorization required) | $300 copay |
| Air ambulance | $300 copay(authorization required) | $300 copay |
| Transportation to plan-approved locations | Not covered | — |
| Medical equipment and supplies | ||
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) | 20% coinsurance |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) | 20% coinsurance |
| Medical supplies | 20% coinsurance(authorization required) | 20% coinsurance |
| Diabetes supplies | 0%–20% coinsurance(authorization required) | 0%–20% coinsurance |
| Diabetic therapeutic shoes or inserts | 20% coinsurance(authorization required) | 20% coinsurance |
| Chiropractic, acupuncture and foot care | ||
| Chiropractic (Medicare-covered) | $15 copay | $15 copay |
| Routine chiropractic care | Not covered | — |
| Acupuncture | Not covered | — |
| Foot exams and treatment (Medicare-covered) | $60 copay | $60 copay |
| Routine foot care | Not covered | — |
| Dental? | ||
| Medicare-covered dental services | $60 copay | $60 copay |
| Oral exams | Not covered | — |
| Cleanings | Not covered | — |
| Fluoride treatment | Not covered | — |
| Dental x-rays | Not covered | — |
| Other diagnostic dental services | Not covered | — |
| Other preventive dental services | Not covered | — |
| Restorative services (fillings, crowns) | Not covered | — |
| Endodontics (root canals) | Not covered | — |
| Periodontics (gum disease) | Not covered | — |
| Dentures and other removable prosthodontics | Not covered | — |
| Maxillofacial prosthetics | Not covered | — |
| Implants | Not covered | — |
| Bridges and other fixed prosthodontics | Not covered | — |
| Oral and maxillofacial surgery | Not covered | — |
| Orthodontics | Not covered | — |
| Adjunctive general services | Not covered | — |
| Vision? | ||
| Eye exam (Medicare-covered) | $60 copay | $60 copay |
| Routine eye exam | $0 copay(limits apply) | $0 copay |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay | $0 copay |
| Contact lenses | Not covered | — |
| Eyeglasses (frames and lenses) | Not covered | — |
| Eyeglass lenses | Not covered | — |
| Eyeglass frames | Not covered | — |
| Eyewear upgrades | Not covered | — |
| Hearing? | ||
| Hearing exam (Medicare-covered) | $60 copay | $60 copay |
| Routine hearing exam | $0 copay(limits apply) | $0 copay |
| Hearing aid fitting and evaluation | Not covered | — |
| Hearing aids (all types) | Not covered | — |
| 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, step therapy may apply) | 0%–20% coinsurance |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) | 0%–20% coinsurance |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) | 0%–20% coinsurance |
| Other extra benefits? | ||
| Over-the-counter (OTC) allowance | Not covered | — |
| Meals after a hospital stay or for a chronic condition | Not covered | — |
| Fitness benefit | $0 copay(limits apply) | 80% coinsurance |
| Health education | Not covered | — |
| Nutritional / dietary benefit | $0 copay(limits apply) | $0 copay |
| Extra smoking and tobacco cessation counseling | $0 copay(limits apply) | $0 copay |
| Enhanced disease management | Not covered | — |
| Telemonitoring | Not covered | — |
| Remote access technologies (web/phone, nurse line) | $0–$60 copay(limits apply) | $0–$60 copay |
| 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, CY2027). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed; an out-of-network dash means the plan files no separate out-of-network cost for that service. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 · Preferred Generic | $0.00 |
| Tier 2 · Generic | $0.00 |
| Tier 3 · Preferred Brand | 25% |
| Tier 4 · Non-Preferred Drug | 30% |
| Tier 5 · Specialty Tier | 25% |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial 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 | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 4: Non-Preferred Drug | 30% | 30% | 30% | 30% | 30% | 30% |
| Tier 5: Specialty Tier | 25% | 25% | 25% | n/a | n/a | n/a |
These are the initial coverage phase amounts, as the plan filed them in its benefit package. The deductible and post-threshold phases are not stated per tier in that filing, so they are not shown here rather than being inferred; the plan's annual out-of-pocket threshold is $2,400.00.
Star rating measures
| Measure | 2027 | 2026 |
|---|---|---|
| Health Plan Customer Service | ||
| Call Center – Foreign Language Interpreter and TTY Availability · C32 | 4 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | too new |
| DD1: Drug Plan Customer Service | ||
| Call Center – Foreign Language Interpreter and TTY Availability · D01 | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | too new |
Measures are paired between the two years by name, not by the C/D number: CMS reuses those numbers, and in 2027 nineteen of them refer to a different measure than they did in 2026. A measure introduced for 2027 has no 2026 score to show. Published per contract — every plan under H6309 shares it.
Also available in 11 other WI counties
Benefits in plain text
HealthPartners Cedar (PPO) (H6309-002-0) is a 2027 PPO Medicare Advantage plan offered by HealthPartners, available to residents of Door County, WI.
The monthly premium is $0.00.
The plan reduces the member's Medicare Part B premium by $50.00 a month (a "giveback"); the Part B premium itself must still be paid.
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
Its in-network out-of-pocket maximum is $9,850.00.
The combined in- and out-of-network out-of-pocket maximum is $14,800.00.
The drug deductible is $700.00. Tier 1 and 2 exempt.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1 (Preferred Generic): $0.00; tier 2 (Generic): $0.00; tier 3 (Preferred Brand): 25%; tier 4 (Non-Preferred Drug): 30%; tier 5 (Specialty Tier): 25%.
Email a copy of the plan benefit details
Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.