Aspirus Health Plan Essential Rx (PPO) 2025 Plan Details for Portage County, Wisconsin Residents
Aspirus Health Plan Essential Rx (PPO) 2025 Plan Details for Portage County, Wisconsin Residents
Navigating your Medicare Advantage options in Portage County for 2025 can be overwhelming, but we're here to help. With Aspirus Health Plan Essential Rx (PPO) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
Based on May, 2025 CMS enrollment data, an estimated 1,704 Medicare beneficiaries are enrolled in this plan, with 241 members in Portage County, WI.
Aspirus Health Plan Essential Rx Overview
| Plan ID H6874-001-0 Overview | |
|---|---|
| Health Plan ID: | H6874-001-0 |
| Medicare Advantage Plan Type: | PPO |
| Plan Year: | 2025 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $4,500.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $245.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Portage County, WI |
| Insured By: | Aspirus Health Plan |
Why Consider Aspirus Health Plan Essential Rx ?
This Medicare Advantage MAPD PPO plan combines full coverage with the flexibility to choose your providers. With a monthly premium of $0.00, it includes all standard Medicare Part A and Part B benefits, plus built-in prescription drug coverage. The annual Part D deductible is $245.00. You can visit any Medicare-approved provider — in or out of network — with lower costs when using in-network services.
Primary care visits have a not covered, and specialist visits come with a $40 copay. Urgent care services carry a $25 copay, and ground ambulance transportation is $300 copay. These costs apply toward your maximum out-of-pocket (MOOP) limit of $4,500.00 . Once that limit is reached, your in-network care is fully covered for the rest of the year.
You’ll find this plan listed by CMS as H6874-001-0. Cost-sharing details are outlined below. Still have questions? Check the FAQ section for more information.
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Out-of-Pocket Costs
With Aspirus Health Plan Essential Rx , you'll have cost-sharing expenses, which are the out-of-pocket costs for approved healthcare services. The table below provides a summary of the typical in-network out-of-pocket costs associated with plan H6874-001-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | Not Covered |
| Specialist: | $40 Copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $100 Copay |
| Urgent care: | $25 Copay |
| Ground ambulance: | $300 Copay |
| Inpatient hospital care: | $400.00 per stay |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $214.00 per day for days 21 through 53 $0.00 per day for days 54 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $45 Copay |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $20 Copay |
| Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | Not Covered |
| Outpatient group therapy: | Not Covered |
| Inpatient psychiatric hospital care: | $400.00 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $40 Copay |
| Occupational therapy: | $40 Copay |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | Not Covered |
| Durable medical equipment: | 20% Coinsurance |
| Prosthetics: | 20% Coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $200 Copay |
| Lab services: | Not Covered |
| Outpatient x-rays: | 20% Coinsurance |
| Diagnostic tests and procedures: | 20% Coinsurance |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | Not Covered |
| Oral exam | |
| Dental x-rays | |
| Cleaning | |
| Periodontics | |
| Endodontics | |
| Restorative Services |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | Covered Limits may apply |
| Hearing aids | Covered Limits may apply |
| Hearing exam | Covered Limits may apply |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $0 to $45 Copay |
| Routine eye exam (in-network) | Covered Limits may apply |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: Yes Eyeglass Frames: Yes Eyewear Upgrades: Yes |
Maximum eyewear benefit: | $250.00 Every year |
Certain preventive services are covered 100% by Aspirus Health Plan Essential Rx as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Aspirus Health Plan Essential Rx includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $0.00 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | ${part_d_lips_amount} |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $245.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Aspirus Health Plan starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Aspirus Health Plan Essential Rx may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic* | $0.00 | $0.00 |
| Generic* | $12.00 | $12.00 |
| Preferred Brand | $47.00 | $47.00 |
| Non-Preferred Drug | $100.00 | $100.00 |
| Specialty Tier | 30.00% | 30.00% |
| *Deductible does not apply. | ||
CMS 5-Star Rating Overview
The Centers for Medicare & Medicaid Services (CMS) reviews and rates Medicare Advantage (Part C) and drug plans (Part D) annually, using a 5-star system to measure aspects such as member satisfaction, preventive services, and management of chronic conditions.
Higher star ratings generally indicate better plan performance, which can be a useful factor to consider when deciding on a plan that aligns with your healthcare goals and preferences.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Eligibility Requirements for Aspirus Health Plan Essential Rx
To qualify for enrollment in Aspirus Health Plan Essential Rx , you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
If you fulfill these criteria, you can enroll in Aspirus Health Plan Essential Rx and enjoy the extensive healthcare benefits it offers.
Enrollment Periods for Aspirus Health Plan Essential Rx
Knowing when you can enroll in Aspirus Health Plan Essential Rx is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) for guidance from a licensed insurance agent.
How to Sign Up for Aspirus Health Plan Essential Rx
Getting started with Aspirus Health Plan Essential Rx is simple. Here are your options:
- Online Enrollment: Easily enroll online using a secure form. Visit the MedicareEnrollment.com enrollment page and follow the steps to complete your enrollment.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will guide you through the process and answer any questions.
- Through Medicare.gov: Enroll through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the instructions to join a Medicare Advantage plan.
- Directly with the Plan: You can also enroll directly with Aspirus Health Plan Essential Rx . The plan's contact information is available below in the "Contact" section.
Be sure to enroll during the appropriate period to ensure your coverage begins without delay.
Here are some of the most frequently asked questions people have about plan ID H6874-001-0:
What’s the monthly premium for Aspirus Health Plan Essential Rx (PPO)?
For 2025, the monthly premium is $0.00, and you still pay your Part B premium to Medicare.
How high can my costs go in a worst-case year?
Your costs top out at $4,500.00 (for in-network services) in 2025; after that the plan pays 100% of covered services.
How much do I pay before drug coverage starts?
You’ll pay the first $245.00 in drug costs before coinsurance kicks in.
How is this plan rated by Medicare?
For 2025, plan H6874-001-0 has a ★4.0 rating. The best rating is 5 stars.
Is Aspirus Health Plan Essential Rx popular?
Enrollment stands at roughly 1,704 members.
Contact Aspirus Health Plan
| Website: | Aspirus Health Plan Plan Page |
|---|---|
| Providers: | Aspirus Health Plan Providers Page |
| Formulary: | Aspirus Health Plan Formulary Page |
| Pharmacy: | Aspirus Health Plan Pharmacy Page |
| New Member Health Plan Help: | (855)931-4859 |
| New Member Health Plan TTY: | (855)931-4852 |
| New Member Part D Help: | (855)931-4859 |
| New Member Part D TTY Users: | (855)931-4852 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- Aspirus Health Plan, http://www.aspirushealthplan.com, Last Accessed June 1, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet", Last Accessed 25 May, 2025
- Medicare.gov, "Joining a plan", Last Accessed 25 May, 2025
- Medicare.gov, "Your coverage options", Last Accessed 25 May, 2025
- CMS.gov, Landscape Source Files, Last Accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 15, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County, Last Accessed June 6, 2025
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