Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H5215-007

Medicare Plan

Network Health Cares (PPO D-SNP) · Network Health Medicare Advantage Plans · Local PPO · East Central Wisconsin

Full CMS plan ID: H5215-007-000

H5215-007-000 is the full CMS identifier for the H5215-007 Medicare plan. Common searches include H5215 007 and H5215007.

Historical 2026 record. Benefits and service areas shown apply to that year.

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Network Health Cares (PPO D-SNP)

H5215-007-000 East Central Wisconsin Local PPO Dual-Eligible

At-a-glance

Quick view

01

In-network

Inpatient hospital

inpatient copayment is selected but its amount is missing

02

Emergency transport

Ambulance

Ground · in-network20% coinsurance
Air · in-network20% coinsurance
03

Emergency services

Emergency room

20% coinsurance

04

Medical maximum

Maximum out-of-pocket

In-network$9,250
Combined in + out$13,900
05

Skilled care at home

Home health

In-networkCost share not reported
Out-of-networkCost share not reported
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + D$21.10 / month

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-network20% coinsurance
Out-of-network20% coinsurance

Specialist

In-network20% coinsurance
Out-of-network20% coinsurance

Preventive care

In-network20% coinsurance
Out-of-network20% coinsurance
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-network20% coinsurance
Out-of-network20% coinsurance

Laboratory services

In-network20% coinsurance
Out-of-network20% coinsurance

X-rays & standard imaging

In-network20% coinsurance
Out-of-network20% coinsurance

MRI, CT & PET imaging

In-network20% coinsurance
Out-of-network20% coinsurance
Urgent & hospital care6 benefits

Urgent care

In-networkCost share not reported
Out-of-networkNot separately reported

Emergency room

In-network20% coinsurance
Out-of-networkNot separately reported

Ground ambulance

In-network20% coinsurance
Out-of-network20% coinsurance

Air ambulance

In-network20% coinsurance
Out-of-network20% coinsurance

Outpatient hospital

In-network20% coinsurance
Out-of-network20% coinsurance

Outpatient surgery / ASC

In-network20% coinsurance
Out-of-network20% coinsurance
Recovery & therapy5 benefits

Home health

In-networkCost share not reported
Out-of-networkCost share not reported

Skilled nursing facility

In-networkCost share not reported
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

In-network20% coinsurance
Out-of-network20% coinsurance

Occupational therapy

In-network20% coinsurance
Out-of-network20% coinsurance

Physical & speech therapy

In-network20% coinsurance
Out-of-network20% coinsurance
Behavioral health2 benefits

Mental health services

In-network20% coinsurance
Out-of-network20% coinsurance

Substance use treatment

In-network20% coinsurance
Out-of-network20% coinsurance
Specialty care2 benefits

Podiatry

In-network20% coinsurance
Out-of-network20% coinsurance

Chiropractic

In-network20% coinsurance
Out-of-network20% coinsurance
Supplemental benefits7 benefits

Dental

In-network20% coinsurance
Out-of-network20% coinsurance

Vision

In-networkCost share not reported
Out-of-network$0 copay

Hearing

In-network$495–$1,695 copay
Out-of-network$40 copay

Transportation

In-networkCost share not reported
Out-of-network$0 copay

Fitness & wellness

In-networkCost share not reported
Out-of-network$0 copay

Over-the-counter allowance

In-networkCost share not reported
Out-of-network$0 copay

Meals

In-networkCost share not reported
Out-of-network$0 copay
Plan costs & rulesCoverage overview

Premium & Part B giveback

$0 Part C premium / month · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-network$9,250
Combined in + out$13,900

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Network & referrals

Local PPO · Referrals: Not required · Out-of-network coverage: Yes

Prescription drugs0 tiers

Part D deductible

Not reported

Using this plan

Understand H5215-007-000

Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

Network Health Cares (PPO D-SNP) is a 2026 Local PPO offered by Network Health Medicare Advantage Plans in East Central Wisconsin. The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. The plan record does not require referrals.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
20% coinsurance
Specialist
20% coinsurance
Laboratory services
20% coinsurance

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
20% coinsurance
MRI, CT & PET imaging
20% coinsurance
Outpatient hospital
20% coinsurance

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
20% coinsurance

Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
East Central Wisconsin (WI)
Plan type
Local PPO
Special Needs Plan
Dual-Eligible
Contract / plan
H5215-007
Coverage year
2026

This is a Dual-Eligible; enrollment requires the plan's specific eligibility criteria as well as residence in its service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

Dental20% coinsurance
VisionCost share not reported
Hearing$495–$1,695 copay
Over-the-counter allowanceCost share not reported
Fitness & wellnessCost share not reported
TransportationCost share not reported
MealsCost share not reported

Plan-specific answers

Frequently asked questions

Where is H5215-007-000 available?

Network Health Cares (PPO D-SNP) is listed for East Central Wisconsin (WI). This is a Dual-Eligible; enrollment requires the plan's specific eligibility criteria as well as residence in its service area.

What is the in-network maximum out-of-pocket limit for H5215-007-000?

The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $9,250. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H5215-007-000?

The listed consolidated Part C and Part D premium is $21.10 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H5215-007-000?

The plan record lists 20% coinsurance.

Does H5215-007-000 report extra benefits?

Yes. CMS reports dental, vision, hearing, over-the-counter allowance, fitness & wellness, and other supplemental benefits. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H5215-007-000 fits

Full CMS plan ID
H5215-007-000
Contract
H5215
Base plan code
H5215-007
Segment
000
Carrier
Network Health Medicare Advantage Plans
Plan type
Local PPO
Service area
East Central Wisconsin (WI)

County/service-area foundation

CMS service-area entries

Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.

  • Brown, WI
  • Calumet, WI
  • Dodge, WI
  • Door, WI
  • Fond du Lac, WI
  • Green Lake, WI
  • Kenosha, WI
  • Kewaunee, WI
  • Manitowoc, WI
  • Marinette, WI
  • Marquette, WI
  • Milwaukee, WI

12 additional service-area entries are retained in the data record.

Same CMS contract

H5215-002-000 Network Health PlusRx (PPO) East Central Wisconsin · Local PPO H5215-005-000 Network Health PremierRx (PPO) East Central Wisconsin · Local PPO H5215-008-000 Network Health Select (PPO) East Central Wisconsin · Local PPO H5215-009-000 Network Health Go (PPO) Southeast Wisconsin · Local PPO H5215-010-000 Network Health Anywhere (PPO) Southeast Wisconsin · Local PPO H5215-011-000 Network Health Choice (PPO) East Central Wisconsin · Local PPO H5215-012-000 Network Health Zero (PPO) East Central Wisconsin · Local PPO H5215-013-000 Network Health Armor (PPO) East Central Wisconsin · Local PPO

About this code

What H5215-007-000 identifies

H5215-007-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H5215-007, H5215 007, or the compact full CMS ID H5215007000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.