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If you have questions about Senior Preferred, please contact us at (800) 394-5566.

 2015 Plan Comparison Guide

To qualify for Senior Preferred, you need to have Medicare Part A and B and be a resident of our service area.  

For a printable version of the Plan Comparison Guide, click here.

Senior Preferred CMS Star Rating Information: Wisconsin and Iowa click here, Minnesota click here

2015 Plan Options   

Elite D Plan

Click here to learn more.

Elite Plan

Click here to learn more.

Value D Plan

Click here to learn more.          

Value Plan

Click here to learn more.             

Monthly Premium

Wisconsin and
Iowa residents:
$176.40
Minnesota residents:
$172.50

Wisconsin and
Iowa residents:
$120
Minnesota residents:
$120

Wisconsin and Iowa residents:
$64.20
Minnesota residents:
$52.40               

Wisconsin and Iowa residents:
$20      

Minnesota residents:
$20                     

Annual out-of-pocket maximum $3,400 $3,400 $3,400 $3,400
Office visit copayment (for doctor & specialist visits)
$20 per visit
$20 per visit
$35 per visit
$35 per visit
Urgent care $20 per visit $20 per visit $35 per visit $35 per visit
Emergency care (worldwide coverage)

$50 copayment





$50 copayment



$50 copayment



$50 copayment



Lab and X-ray
Covered at 100%
Covered at 100%
You pay up to 10%
You pay up to 10%
Hospital copayment $500 per admission
$500 per admission

$200 per day for days 1-17

$0 copay days 18-90

$200 per day for days 1-17

$0 copay days 18-90

Skilled nursing facility (prior 3-day hospital stay required)

Days 1-20: $0 copay

Days 21-100: $125 copay per day

Days 1-20: $0 copay

Days 21-100: $125 copay per day

Days 1-20: $0 copay

Days 21-100: $125 copay per day

Days 1-20: $0 copay

Days 21-100: $125 copay per day

Vision

$20 copayment for exam

$300 
for eyewear 
(glasses + lenses)

$20 copayment for
exam

$300 
for eyewear 
(glasses + lenses)

$35 copayment
for exam     

$100 
for eyewear 
(glasses + lenses) 
$35 copayment
for exam        

$100 
for eyewear 
(glasses + lenses) 
Preventive exams and services
Many preventive services are covered in full
Many preventive services are covered in full
Many preventive services are covered in full
Many preventive services are covered in full
Part D Prescription Drug Coverage 

Includes Part D coverage

Does not include Part D coverage

Includes Part D coverage

Does not include Part D coverage
Part D Prescription Drug Copayments Learn more about   drug copayments Not applicable Learn more about drug copayments Not applicable
 
Evidence of Coverage (EOC) 
This document provides a detailed description of each plan.

Elite D Plan

Elite Plan

Value D Plan

Value Plan

Our network Senior Preferred is an HMO Medicare Advantage product. Our members receive medical care through Gundersen Health Plan Senior Preferred's network of healthcare providers and facilities (except in urgent or emergency care situations when a member is out of the service area).
Summary of Benefits
This document compares all four plan options.

Interpreter Services Information (multi-language insert)

How to get care from out of network providers

In most cases, care you receive from an out-of-network provider (a provider who is not part of our plan’s network) will not be covered. These are three exceptions:

  1. The plan covers emergency care or urgently needed care that you get from an out-of-network provider. For more information about this, and to see what emergency or urgently needed care means, see Section 3 in the Evidence of Coverage (links to the Evidence of Coverage documents can be found above).
  2. If you need medical care that Medicare requires our plan to cover and the providers in our network cannot provide this care, you can get this care from an out-of-network provider. If your network provider suggests or recommends care out-of-network, a referral must be obtained in writing, and signed by the plan’s medical director prior to seeking care. In this situation, you will pay the same as you would pay if you got the care from a network provider.
  3. Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area.

Using a pharmacy that is out of the network
There are special circumstances when our plan will cover prescriptions from out of network providers/pharmacies; they are as follows:

1. Drugs may be covered for an illness while members are travelling outside of the plan’s service area and where there are no network pharmacies.

2. Part D vaccines administered in a clinic or hospital setting which are considered out of network.

In the event you are unable to use an in network pharmacy and none of the above scenarios would apply; you must have prior authorization (advance approval) from our plan to get prescriptions from an out-of-network pharmacy provider. If you pay out-of-pocket for a prescription and you feel we should cover this expense, please contact us or send the bill to us for payment review. You can find more detailed information regarding how this is done in your Evidence of Coverage in Chapter 7, section 2.1.

Contact Information

If you have questions or require language assistance, please call Customer Service at (800) 394-5566. For people who are deaf, hard of hearing, or speech impaired please call TTY/TDD 711 or toll free (800) 877-8973, or you may call through a video relay service company of your choice.  Interpreter services are provided free of charge to you. A customer service representative is available to assist you Monday through Friday from 8 a.m. to 8 p.m. From October 1 through February 14 we are also available to assist you on Saturdays and Sundays from 8 a.m. to 8 p.m. If you would like to meet with a customer service representative in person, you can visit us during our office hours, Monday through Friday. Our office locations and hours are:

  • 3190 Gundersen Drive, Onalaska, Wisconsin from 8 a.m. to 5 p.m. and 
  • 1836 South Avenue, La Crosse, Wisconsin, (located on the first floor in the lobby of the Gundersen Clinic Resource Center) from 8 a.m. to 4:30 p.m.
Disclaimers

Senior Preferred is an HMO plan with a Medicare contract. Enrollment in Senior Preferred depends on contract renewal. Medicare Advantage & Part D contracts are reviewed annually by The Centers for Medicare and Medicaid Services to determine renewal status of the plan. You must continue to pay your Medicare Part B premium. The benefit information provided herein is a brief summary, not a comprehensive description of benefits.  Members must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis. For more information contact the plan. *Plan performance summary star ratings are assessed each year and may change from one year to the next.

This web page was last updated on June 5, 2015.

Y0092_14 21 CMS Approved