Aspirus Health Plan
Medicare Advantage
You trust Aspirus Health for your care. Now you can trust Aspirus Health Plan with your Medicare Advantage coverage. We offer all the benefits you need without leaving the network you know.
Your Medicare Advantage Partner
Our Medicare Advantage plans are available for a $0 premium*, so you can get the care you need without breaking your budget.
*You will continue to pay your Medicare Part B premium.
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
- $25 monthly Medicare Part B premium giveback with our Elite plan
Extra benefits for your health and wellness
- Rewards and incentives. Earn rewards for taking care of your health.
- One Pass®. Be healthy and feel stronger with a free gym membership to more than 24,000 participating locations nationwide, online classes, at-home fitness kits, brain training, no-cost social events and more.
- Quit Smoking and Vaping Program. 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. Use the allowance to buy eligible health items including cough drops, first aid supplies, pain relievers and more at participating stores.
- Aspirus Health Plan 24/7 Nurse Line. For reliable health information 24 hours a day, seven days a week, Aspirus Health Plan members can call the 24/7 Nurse Line.
- Medication Therapy Management (MTM). 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.
Additional links and documents
- Medicare coverage updates
- Aspirus Health Plan Service Area Map (PDF)
- Medicare Complaint Form (external site)
- Rights and Responsibilities upon Disenrollment (PDF)
- Privacy notice (PDF)
2026 Plans
Essential Rx (PPO)
2026 monthly premium
$0*
*You must continue to pay your Medicare Part B premium.
Doctor visits
Primary: $0 copay
Specialist: $45 copay
Out-of-pocket maximum
In- and out-of-network combined: $5,500
Elite (PPO)
2026 monthly premium
$0*
*You must continue to pay your Medicare Part B premium.
Medicare Part B premium giveback
$25 per month
Doctor visits
Primary: $0 copay
Specialist: $45 copay
Out-of-pocket maximum
In- and out-of-network combined: $3,200
Preventive care
$0 copay for many services
Inpatient hospital
$400 copay per stay; then 100% covered
Outpatient surgery/services
and observation stay
$295 copay
Emergency care (worldwide)
$130 copay
Dental coverage
Includes routine dental with optional coverage available
Lab services
$0 copay
Out-of-network coverage with any provider that accepts Medicare
Cost-sharing is the same for both in- and out-of-network for some services
Most non-emergency out-of-network services at Medicare providers covered at 30% coinsurance
Over-the-counter (OTC) allowance
$80 every three months (does not rollover)
One Pass fitness program
Basic health club membership, online classes and brain training
Medicare Part D prescription drug coverage
Annual deductible: $350 (except tiers 1 and 2)
Tier 1 = $0 copay
Tier 2 = $10 copay
Tier 3 = 20% coinsurance
Tier 4 = 40% coinsurance
Tier 5 = 29% coinsurance
Copays based on drug tiers, as low as $0.
Vision coverage
$0 copay for routine eye exam
$45 copay for diagnostic eye exam
$250 prescription eyewear/contacts allowance
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
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)
$130 copay
Dental coverage
Includes routine dental with optional coverage available
Lab services
$0 copay
Out-of-network coverage with any provider that accepts Medicare
Cost-sharing is the same for both in- and out-of-network for some services
Most non-emergency out-of-network services at Medicare providers covered at 30% coinsurance
Over-the-counter (OTC) allowance
$75 every six months (does not rollover)
One Pass fitness program
Basic health club membership, online classes and brain training
Medicare Part D prescription drug coverage
Not covered
Vision coverage
$0 copay for routine eye exam
$40 copay for diagnostic eye exam
$175 prescription eyewear/contacts allowance
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
2025 Plans
Essential Rx (PPO)
2025 monthly premium
$0*
*You must continue to pay your Medicare Part B premium
Doctor visits
Primary: $0 copay
Specialist: $40 copay
Out-of-pocket maximum
In- and out-of-network combined: $4,500
Elite (PPO)
2025 monthly premium
$0*
*You must continue to pay your Medicare Part B premium
Medicare Part B premium giveback
$25 per month
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
$400 copay per stay; then 100% covered
Outpatient surgery/services
and observation stay
$295 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
Cost-sharing is the same for both in- and out-of-network for some services
Most non-emergency out-of-network services at Medicare providers covered at 30% coinsurance
Over-the-counter (OTC) allowance
$75 each month (does not rollover)
One Pass fitness program
Basic health club membership, online classes and brain training
Medicare Part D prescription drug coverage
Annual deductible:
Tier 1 & 2 = $0
Tiers 3–5 = $245
Copays based on drug tiers, as low as $0
Vision coverage
$0 copay for routine eye exam
$45 copay for diagnostic eye exam
$250 prescription eyewear/contacts allowance
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
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
Cost-sharing is the same for both in- and out-of-network for some services
Most non-emergency out-of-network services at Medicare providers covered at 30% coinsurance
Over-the-counter (OTC) allowance
$75 twice a year (does not rollover)
One Pass fitness program
Basic health club membership, online classes and brain training
Medicare Part D prescription drug coverage
Not covered
Vision coverage
$0 copay for routine eye exam
$40 copay for diagnostic eye exam
$175 prescription eyewear/contacts allowance
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, Inc. is a PPO plan with a Medicare contract. Enrollment in Aspirus Health Plan, Inc. depends on contract renewal.