Aspirus Health Plan Medicare Advantage
You trust Aspirus Health 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.
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 (you will continue to pay your Medicare Part B premium) and pay a little more for care if you need it. Or pay a little more in premium and save on out-of-pocket costs when you need care.
Among the benefits you’ll enjoy:
- Dental, hearing aids and eyewear coverage
- Coverage anywhere in the U.S. when you see a Medicare provider
- Lower costs through the Aspirus Health network
Extra benefits for your health and wellness
- One Pass™. Be healthy, feel stronger, and have fun with the One Pass™ fitness benefit, including a free fitness club membership at over 23,000 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. 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 four parts of Medicare, what they cover, when to enroll, and how to enroll.
2023 Plans
Important plan documents
Is your doctor in-network?
Provider and Pharmacy directory
Are your drugs covered?
Formulary (list of covered drugs)
Learn about our 2023 Plans
Summary of benefits
Essential Rx (PPO)
$0.00
2023 Monthly Premium
*You must continue to pay your Part B premium
Doctor visits
Primary: $0 copay
Specialist: $40 copay
Out-of-pocket maximum
In and Out-of-network combined: $4,500
Preventive care
$0 copay for many services
Inpatient hospital
$300 copay per day (days 1–5); then 100% covered
Outpatient surgery/services
and observation stay
$395 copay
Emergency care (worldwide)
$100 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; cost-sharing is the same both in- and out-of-network for some services
Over-the-counter (OTC) allowance
$100 twice a year (does not rollover)
One Pass™ fitness program
Includes basic health club membership
Medicare Part D prescription drug coverage
Annual deductible:
Tier 1 & 2 = $0
Tiers 3–5 = $245
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
$3 copay at a preferred pharmacy^
Hearing coverage (routine exam and hearing aids from TruHearing)
$0 copay for routine hearing exam
$45 copay for diagnostic hearing exam
$699 copay Advanced Hearing Aid
$999 copay Premium Hearing Aid
^Aspirus Health Plan preferred pharmacies offer lower cost sharing.
Elite Rx (PPO)
$77.00
2023 Monthly Premium
*You must continue to pay your Part B premium
Doctor visits
Primary: $0 copay
Specialist: $40 copay
Out-of-pocket maximum
In and Out-of-network combined: $3,200
Preventive care
$0 copay for many services
Inpatient hospital
$300 copay per stay; then 100% covered
Outpatient surgery/services
and observation stay
$195 copay
Emergency care (worldwide)
$100 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; cost-sharing is the same both in- and out-of-network for some services
Over-the-counter (OTC) allowance
$75 twice a year (does not rollover)
One Pass™ fitness program
Includes basic health club membership
Medicare Part D prescription drug coverage
Annual deductible:
Tier 1 & 2 = $0
Tiers 3–5 = $245
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
$2 copay at a preferred pharmacy^
Hearing coverage (routine exam and hearing aids from TruHearing)
$0 copay for routine hearing exam
$40 copay for diagnostic hearing exam
$599 copay Advanced Hearing Aid
$899 copay Premium Hearing Aid
^Aspirus Health Plan preferred pharmacies offer lower cost sharing.
Elite (PPO)
$0.00
2023 Monthly Premium
*You must continue to pay your Part B premium
Doctor visits
Primary: $0 copay
Specialist: $40 copay
Out-of-pocket maximum
In and Out-of-network combined: $3,200
Preventive care
$0 copay for many services
Inpatient hospital
$300 copay per stay; then 100% covered
Outpatient surgery/services
and observation stay
$195 copay
Emergency care (worldwide)
$100 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; cost-sharing is the same both in- and out-of-network for some services
Over-the-counter (OTC) allowance
$75 twice a year (does not rollover)
One Pass™ 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 (routine exam and hearing aids from TruHearing)
$0 copay for routine hearing exam
$40 copay for diagnostic hearing exam
$599 copay Advanced Hearing Aid
$899 copay Premium Hearing Aid
Additional Links and Documents
- Medicare coverage updates
- Part D Coverage Determinations, Appeals and Grievances
- Part C Organizational Determinations, Appeals and Grievances
- Aspirus Health Plan Service Area Map
- Medicare Complaint Form (external site)
- Rights and Responsibilities upon Disenrollment (PDF)
- Privacy notice (PDF)
Aspirus Health Plan, Inc. is a PPO plan with a Medicare contract. Enrollment in Aspirus Health Plan, Inc. depends on contract renewal.