NetworkCares

NetworkCares is a Medicare Special Needs plan offered by Network Health Insurance Corporation, a preferred provider organization serving Northeast Wisconsin since 1982. NetworkCares is a Medicare Advantage plan that is designed for people who have both Medicare and Medicaid. When you join NetworkCares, you get all your Medicare Part A, Part B, and Medicare Part D prescription drug coverage through this plan. Some or all of your health care costs may be covered based on your level of Medicaid eligibility. You'll also receive supplemental benefits tailored to keep you healthy. For more information on the benefits of the NetworkCares plan, read the explanations below or go to the Summary of Benefits for details and coverage comparison charts.

COVERAGE DETAILS FOR NETWORKCARES:

Medicare Prescription drug benefit

NetworkCares covers Medicare Part D prescription drugs with a $0 copay for generic drugs. The plan uses a formulary that meets the Medicare guidelines for comprehensive coverage. Network Health Insurance Corporation has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area.

Back to Top

Inpatient hospitalization

NetworkCares covers 90 days each benefit period for in-network hospital stays. When you visit out-of-network hospitals, there is a $0 copay for the first 60 days you are hospitalized. You pay $260 per day from 61 to 90 days.

Back to Top

Diabetes self-monitoring training and medical nutrition therapy

Whether in or out-of-network, you could pay as little as 0% of the cost for diabetes self-monitoring training, nutrition therapy, and supplies.

Back to Top

Diagnostic tests, X-rays and lab services

With NetworkCares, you are covered up to 80% of the cost for Medicare-covered lab services.

Back to Top

Emergency and urgently needed care

When you are in-network, you are covered up to 80% for Medicare-covered emergency room visits. Out-of-network, you are not covered outside the U.S. except under limited circumstances. Contact the plan for more details. No matter where you are, if you are admitted to the hospital within 24-hours for the same condition, you pay $0 for the emergency room visit.

Back to Top

Supplemental Benefits

With NetworkCares, you also have supplemental benefits that are tailored to keep you healthy, such as:

• Respite Care is care given to a patient by another caregiver so that the usual caregiver can rest. This benefit will include home health care visits by a nurse, a home health aide, or a personal care aide. It allows up to 7 visits per week and has an annual maximum benefit of $1,600.
• Preventive Dental Benefits will include routine dental exams, cleanings, and fluoride treatments every 6 months. Basic dental x-rays are available each year, and full mouth x-rays are available every 3 years. Please see the Provider Lookup for an up-to-date list of doctors in the network.
• Home Safety and Fall Prevention Assessment will include a visit from a qualified health care professional who will assess your home and make recommendations for changes to result in better home safety. After these recommendations are made and agreed upon by you, the Home Adaptation Service can be used. This assessment can be done yearly and the benefit amount is $200.
• Home Adaptation Service offers $300 every year to adapt your home to make it safer for you. This benefit is dependent upon completion of the Home Safety and Fall Prevention Assessment mentioned above.

Back to Top

Preventive services

NetworkCares offers these preventive screenings each year at no extra cost to you:

• Bone Mass Measurements
• Colorectal Screening Exams
• Immunizations
• Mammograms
• Pap Smears and Pelvic Exams
• Prostate Cancer Screenings

Back to Top

Pre-authorization

Some of the covered services listed in the Benefits Chart are covered only if your NetworkCares plan doctor or other plan provider gets “prior authorization” (approval in advance) from Network Health Insurance Corporation. In these cases, you need to have prior authorization when you see plan providers. Covered services that need prior authorization will be stated in the Benefits Chart. You will pay more if you receive these services from a non-plan physician or provider.

Back to Top

Health and wellness education – after-hours information

NetworkCares offers a variety of Health Education and Disease Management services. For additional information on the services and the benefits available to you, contact the NetworkCares Customer Service Department at 1-800-378-5234, Monday, Wednesday, Thursday and Friday, 8 a.m. to 5 p.m., and Tuesday, 8 a.m. to 4 p.m. Hearing impaired may call TTY/TDD 1-800-947-3529.

Back to Top

Enroll NOW

You can join NetworkCares if you are entitled to Medicare Part A, enrolled in Part B, and live in the service area.

You must also receive medical assistance from the state to join the plan.

Please click here or call the plan to see if you are eligible to join.

Back to Top

Your premiums

When you join NetworkCares, your monthly plan premium will be $0. Members must continue to pay Medicare Part B premiums unless otherwise paid for under Medicaid or by another third-party.

We want you to be healthy – and happy

If at any time you’re unsatisfied with the care you receive from the NetworkCares plan, you have the right to make a complaint through our Grievance and Appeals Procedures.

Additionally, if you have problems getting the prescription drugs you think we should provide, there are actions you can take to initiate a Coverage Determination or Exceptions Process, and request payment.

Back to Top