Company vs company · Door County, WI · 2027 plan year
Network Health Medicare Advantage Plans vs HealthPartners Medicare Advantage plans
Medicare.gov compares Medicare Advantage plans with each other. This page also shows Original Medicare, so you can see the full trade-off: premiums, copays, the yearly limit, extra benefits, and the rules about doctors and approvals.
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In most states, including Wisconsin, you cannot count on getting Medigap later
You can buy any Medigap plan with no health questions in the 6 months that start when you are 65 or older and have Part B. After that, a Medigap company in Wisconsin can ask about your health. It can say no, or it can charge you more. So if you join a Medicare Advantage plan now, you may not be able to get Medigap later.
One exception is the trial right. If you joined Medicare Advantage when you first got Medicare at 65, or you left a Medigap plan to try Medicare Advantage for the first time, you can switch back within 12 months. Then you can buy a Medigap plan with no health questions.
Read about Medigap rights on Medicare.govYour yearly cost, side by side
Move the controls to match your year. Totals include premiums, the Part B premium, copays, and drug costs.
Medigap plan with Original Medicare
Wisconsin sets its own Medigap plans: a basic plan with optional riders, two cost-sharing plans, and a high-deductible plan. These plans are not the plans with letters, such as Plan G and Plan N. We have no prices for these plans, so the totals show Original Medicare without Medigap. Without Medigap you pay 20% of most costs, with no yearly limit. Check Medigap plans and prices for ZIP 54235 on Medicare.gov
Want to check your exact drugs? Medicare.gov lets you enter each drug and shows what each plan charges for it. Enter your drugs on Medicare.gov
Original Medicare
With no Medigap and AARP Medicare Rx Saver from UHC (PDP)
$6,133 a year
- Premiums
- $2,638
- Medical costs
- $1,616
- Drugs
- $1,880
No yearly limit on what you pay for medical care.
Network Health Select (PPO)
PPO from Network Health Medicare Advantage Plans
$5,967 a year
- Premiums
- $2,514
- Medical costs
- $1,833
- Drugs
- $1,620
Most you can pay in a bad year, before drugs: $6,964.
HealthPartners Cedar (PPO)
PPO from HealthPartners
$5,827 a year
- Premiums
- $1,914
- Medical costs
- $1,738
- Drugs
- $2,175
Most you can pay in a bad year, before drugs: $11,764.
With these settings, HealthPartners Cedar (PPO) costs about $140 less a year than Network Health Select (PPO).
These are estimates, not quotes. Check every number with Medicare (Medicare.gov or 1-800-MEDICARE) and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Drug costs use typical prices for generic and brand-name drugs. Original Medicare amounts are 2027 projections from the 2026 Medicare Trustees Report. CMS sets the final amounts in November.
Text us about this comparisonWhat you pay each time you get care
In-network costs for one visit or one stay. The Original Medicare amounts follow your Medigap choice above: no Medigap.
Primary doctor visit
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Network Health Select (PPO)
$0 copay
Network Health Choice (PPO)
$0
HealthPartners Birch (PPO)
$0 copay
HealthPartners Cedar (PPO)
$0 copay
Specialist visit
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Network Health Select (PPO)
$60
Prior authorizationNetwork Health Choice (PPO)
$50
Prior authorizationHealthPartners Birch (PPO)
$0-$55
HealthPartners Cedar (PPO)
$0-$60
Lab tests
Original Medicare, no Medigap
$0
most Medicare-covered tests
Network Health Select (PPO)
$0-$20
Prior authorizationNetwork Health Choice (PPO)
$0-$40
Prior authorizationHealthPartners Birch (PPO)
10%
Prior authorizationHealthPartners Cedar (PPO)
10%
Prior authorization
MRI or CT scan
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Network Health Select (PPO)
$0-$300
Prior authorizationNetwork Health Choice (PPO)
$0-$295
Prior authorizationHealthPartners Birch (PPO)
$0-$500
Prior authorizationHealthPartners Cedar (PPO)
$0-$500
Prior authorization
Emergency room
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Network Health Select (PPO)
$130
Network Health Choice (PPO)
$130
HealthPartners Birch (PPO)
$130
HealthPartners Cedar (PPO)
$115
Urgent care
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Network Health Select (PPO)
$60
Network Health Choice (PPO)
$50
HealthPartners Birch (PPO)
$50
HealthPartners Cedar (PPO)
$40
Outpatient surgery
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Network Health Select (PPO)
$250
Prior authorizationNetwork Health Choice (PPO)
$0-$200
Prior authorizationHealthPartners Birch (PPO)
$500
Prior authorizationHealthPartners Cedar (PPO)
$500
Prior authorization
Ground ambulance
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Network Health Select (PPO)
$300
Prior authorizationNetwork Health Choice (PPO)
$275
Prior authorizationHealthPartners Birch (PPO)
$300
Prior authorizationHealthPartners Cedar (PPO)
$300
Prior authorization
Hospital stay, 5 days
Original Medicare, no Medigap
$1,788
Part A deductible each benefit period; $447 a day for days 61-90
Network Health Select (PPO)
$1,700
for a 5-day stay
Prior authorizationNetwork Health Choice (PPO)
$1,700
for a 5-day stay
Prior authorizationHealthPartners Birch (PPO)
$2,750
for a 5-day stay
Prior authorizationHealthPartners Cedar (PPO)
$2,400
for a 5-day stay
Prior authorization
See every cost in one table
| What you pay in network | Original Medicare, no Medigap | Network Health Select (PPO) | Network Health Choice (PPO) | HealthPartners Birch (PPO) | HealthPartners Cedar (PPO) |
|---|---|---|---|---|---|
| Monthly premium | Part B $209.50 + drug plan $10.30 | $0 + Part B $209.50 | $0 + Part B $209.50 | $0 + Part B $209.50 | $0 (pays back $50 a month of your Part B premium) + Part B $209.50 |
| Yearly limit on what you pay | No yearly limit | $4,450 in network; $4,450 in and out of network | $5,100 in network; $5,100 in and out of network | $6,750 in network; $10,000 in and out of network | $9,850 in network; $14,800 in and out of network |
| Medical deductible | $292 Part B; $1,788 Part A each benefit period | $200 | $500 | $0 | $0 |
| Primary doctor visit | 20%, after the $292 yearly Part B deductible | $0 copay | $0 copay | $0 copay | $0 copay |
| Specialist visit | 20%, after the $292 yearly Part B deductible | $60 copayPrior authorization | $50 copayPrior authorization | $0-$55 copay | $0-$60 copay |
| Lab tests | $0, most Medicare-covered tests | $0-$20 copayPrior authorization | $0-$40 copayPrior authorization | 10% coinsurancePrior authorization | 10% coinsurancePrior authorization |
| MRI or CT scan | 20%, after the $292 yearly Part B deductible | $0-$300 copayPrior authorization | $0-$295 copayPrior authorization | $0-$500 copayPrior authorization | $0-$500 copayPrior authorization |
| X-rays | 20%, after the $292 yearly Part B deductible | $40 copayPrior authorization | $90 copayPrior authorization | $100 copayPrior authorization | $125 copayPrior authorization |
| Emergency room | 20%, after the $292 yearly Part B deductible | $130 copay | $130 copay | $130 copay | $115 copay |
| Urgent care | 20%, after the $292 yearly Part B deductible | $60 copay | $50 copay | $50 copay | $40 copay |
| Outpatient hospital | 20%, after the $292 yearly Part B deductible | $300 copayPrior authorization | $0-$300 copayPrior authorization | $600 copayPrior authorization | $600 copayPrior authorization |
| Surgery center | 20%, after the $292 yearly Part B deductible | $250 copayPrior authorization | $0-$200 copayPrior authorization | $500 copayPrior authorization | $500 copayPrior authorization |
| Ground ambulance | 20%, after the $292 yearly Part B deductible | $300 copayPrior authorization | $275 copayPrior authorization | $300 copayPrior authorization | $300 copayPrior authorization |
| Hospital stay | $1,788, Part A deductible each benefit period; $447 a day for days 61-90 | $340 per day for days 1-6; $0 per day for days 7-90Prior authorization | $340 per day for days 1-7; $0 per day for days 8-90Prior authorization | $550 per day for days 1-5; $0 per day for days 6-90Prior authorization | $600 per day for days 1-4; $0 per day for days 5-90Prior authorization |
| Skilled nursing facility | $0, days 1-20, then $223.50 a day for days 21-100 | $0 per day for days 1-20; $221 per day for days 21-45; $0 per day for days 46-100Prior authorization | $0 per day for days 1-20; $221 per day for days 21-45; $0 per day for days 46-100Prior authorization | $0 per day for days 1-20; $221 per day for days 21-100Prior authorization | $0 per day for days 1-20; $221 per day for days 21-100Prior authorization |
| Mental health visit | 20%, after the $292 yearly Part B deductible | $40 copayPrior authorization | $50 copayPrior authorization | $55 copay | $50 copay |
| Physical therapy | 20%, after the $292 yearly Part B deductible | $55 copayPrior authorization | $50 copayPrior authorization | $50 copay | $35 copay |
| Home health care | $0, Medicare-covered home health | $0 copayPrior authorization | $0 copayPrior authorization | $0 copayPrior authorization | $0 copayPrior authorization |
| Medical equipment | 20%, after the $292 yearly Part B deductible | 0%-20% coinsurancePrior authorization | 0%-20% coinsurancePrior authorization | 20% coinsurancePrior authorization | 20% coinsurancePrior authorization |
| Part B drugs | 20% after the $292 Part B deductible | 0%-20% coinsurancePrior authorization | 0%-20% coinsurancePrior authorization | 0%-20% coinsurancePrior authorization | 0%-20% coinsurancePrior authorization |
| Drug deductible (Part D) | $700 with AARP Medicare Rx Saver from UHC (PDP) | $330 | $300 | $700 | $700 |
| Drug tiers (one month, retail) | Preferred Generic: $0 copayGeneric: $5 copayPreferred Brand: 20% coinsuranceNon-Preferred Drug: 31% coinsuranceSpecialty Tier: 25% coinsurance | Preferred Generic: $1 copayGeneric: $8 copayPreferred Brand: 20% coinsuranceNon-Preferred Drug: 37% coinsuranceSpecialty Tier: 29% coinsurance | Preferred Generic: $1 copayGeneric: $8 copayPreferred Brand: 22% coinsuranceNon-Preferred Drug: 31% coinsuranceSpecialty Tier: 30% coinsurance | Preferred Generic: $0 copayGeneric: $0 copayPreferred Brand: 25% coinsuranceNon-Preferred Drug: 35% coinsuranceSpecialty Tier: 25% coinsurance | Preferred Generic: $0 copayGeneric: $0 copayPreferred Brand: 25% coinsuranceNon-Preferred Drug: 30% coinsuranceSpecialty Tier: 25% coinsurance |
Not sure which of these costs apply to you?
Text us what you have now. We will help you read this comparison and check it with Medicare.gov.
A higher drug plan premium is not, by itself, a reason to switch
With Original Medicare, you buy a separate drug plan. In Wisconsin, 8 drug plans are for sale for 2027, from $5.30 to $189.10 a month. Half of them cost $10.85 a month or less.
- Every 2027 drug plan limits what you pay for covered drugs to $2,400 a year. The drug coverage in Medicare Advantage plans has the same limit.
- The premium is one part of your yearly cost. The calculator above adds premiums, medical costs, and drug costs, so you can see the whole year.
- A Medicare Advantage plan can cost less in a light year. But you also take on its network and prior authorization rules, and you may not be able to get Medigap later.
- If your income is limited, Extra Help can pay most of your drug plan premium and drug costs. Check Extra Help at SSA.gov
The two companies in Door County
Network Health Medicare Advantage Plans
- 5 plans for 2027 (not counting special needs plans)
- 3 with a $0 premium; 1 pay back part of your Part B premium
- Yearly limits from $3,400 to $5,100
- Star ratings 4 to 4
- Network Health Select (PPO) · $0 a month · limit $4,450
- Network Health Choice (PPO) · $0 a month · limit $5,100
- Network Health Armor (PPO) · $0 a month · limit $4,900
- Network Health PlusRx (PPO) · $105 a month · limit $3,400
- Network Health PremierRx (PPO) · $257 a month · limit $3,400
HealthPartners
- 2 plans for 2027 (not counting special needs plans)
- 2 with a $0 premium; 1 pay back part of your Part B premium
- Yearly limits from $6,750 to $9,850
- Star ratings not rated
- HealthPartners Birch (PPO) · $0 a month · limit $6,750
- HealthPartners Cedar (PPO) · $0 a month · limit $9,850
Doctors, referrals, and prior authorization
Cost is one side. The other side is how you get care. These rules come from the CMS plan files. Prior authorization means the plan must approve a service before you get it.
Original Medicare
- Any doctor or hospital in the U.S. that takes Medicare
- No referrals
- Prior authorization only for a short list of services
Network Health Select (PPO)
PPO
- The plan has a network. You can go outside it, but you pay more.
- No referral needed to see a specialist.
Prior authorization for 21 services
Specialist visits, Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Observation stay, Surgery center, Ambulance, Mental health visits, Psychiatrist visits, Physical therapy, Occupational therapy, Home health, Partial hospitalization, Medical equipment, Prosthetics, Diabetic supplies, Substance use care, Hospital stay, Skilled nursing, Part B drugs
Network Health Choice (PPO)
PPO
- The plan has a network. You can go outside it, but you pay more.
- No referral needed to see a specialist.
Prior authorization for 21 services
Specialist visits, Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Observation stay, Surgery center, Ambulance, Mental health visits, Psychiatrist visits, Physical therapy, Occupational therapy, Home health, Partial hospitalization, Medical equipment, Prosthetics, Diabetic supplies, Substance use care, Hospital stay, Skilled nursing, Part B drugs
HealthPartners Birch (PPO)
PPO
- The plan has a network. You can go outside it, but you pay more.
- No referral needed to see a specialist.
Prior authorization for 13 services
Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Surgery center, Ambulance, Home health, Medical equipment, Prosthetics, Diabetic supplies, Hospital stay, Skilled nursing, Part B drugs
HealthPartners Cedar (PPO)
PPO
- The plan has a network. You can go outside it, but you pay more.
- No referral needed to see a specialist.
Prior authorization for 13 services
Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Surgery center, Ambulance, Home health, Medical equipment, Prosthetics, Diabetic supplies, Hospital stay, Skilled nursing, Part B drugs
Extra benefits
| Extra benefit | Original Medicare | Network Health Select (PPO) | Network Health Choice (PPO) | HealthPartners Birch (PPO) | HealthPartners Cedar (PPO) |
|---|---|---|---|---|---|
| Dental | No | Comprehensive, up to $400 a year | Comprehensive, up to $1,000 a year | Preventive only | Not covered |
| Eye exam | No | Yes | Yes | Yes | Yes |
| Glasses or contacts | No | Yes | No | Yes, $150 allowance | No |
| Hearing aids | No | Yes, up to $75 | Yes, up to $75 | No | No |
| Over-the-counter allowance | No | $400 a year | No | No | No |
| Fitness benefit | No | Yes | Yes | Yes | Yes |
| Rides to care | No | Yes | No | No | No |
| Meals after a hospital stay | No | No | No | No | No |
| Emergency care abroad | No, unless your Medigap plan pays for it | Yes | Yes | Yes | Yes |
| Part B premium giveback | No | No | No | No | $50 a month |
What changed for 2027
Network Health Select (PPO)
Consolidated Renewal Plan · 2026 plan H5215-008-0
- In-network out-of-pocket maximum up from $3,900 to $4,450
- Medical deductible up from $0 to $200
- Part B giveback down from $3 to $0
- Diagnostic radiology (MRI, CT): $40-$300 copay to $0-$300 copay
- Inpatient hospital: $275 per day for days 1-6; $0 per day for days 7-90 to $340 per day for days 1-6; $0 per day for days 7-90
- Skilled nursing facility: $0 per day for days 1-20; $218 per day for days 21-45; $0 per day for days 46-100 to $0 per day for days 1-20; $221 per day for days 21-45; $0 per day for days 46-100
- Dental maximum down from $460 to $400
- Yearly OTC allowance down from $550 to $400
- Meals after a hospital stay removed
- Overall star rating down from 4.5 to 4
Network Health Choice (PPO)
Renewal Plan · 2026 plan H5215-011-0
- In-network out-of-pocket maximum up from $4,700 to $5,100
- Medical deductible up from $0 to $500
- Part B giveback down from $24 to $0
- Diagnostic radiology (MRI, CT): $90-$295 copay to $0-$295 copay
- Outpatient hospital: $300 copay to $0-$300 copay
- Inpatient hospital: $315 per day for days 1-7; $0 per day for days 8-90 to $340 per day for days 1-7; $0 per day for days 8-90
- Skilled nursing facility: $0 per day for days 1-20; $218 per day for days 21-45; $0 per day for days 46-100 to $0 per day for days 1-20; $221 per day for days 21-45; $0 per day for days 46-100
- Dental maximum down from $1,500 to $1,000
- Eyewear removed
- OTC allowance removed
- Overall star rating down from 4.5 to 4
HealthPartners Birch (PPO)
Renewal Plan · 2026 plan H6309-001-0
- In-network out-of-pocket maximum up from $5,000 to $6,750
- Drug deductible up from $300 to $700
- Specialist visit: $50 copay to $0-$55 copay
- Diagnostic radiology (MRI, CT): $300 copay to $0-$500 copay
- Outpatient hospital: $400 copay to $600 copay
- Inpatient hospital: $375 per day for days 1-5; $0 per day for days 6-90 to $550 per day for days 1-5; $0 per day for days 6-90
- Skilled nursing facility: $0 per day for days 1-20; $218 per day for days 21-100 to $0 per day for days 1-20; $221 per day for days 21-100
- Comprehensive dental removed
- Hearing aids removed
- Meals after a hospital stay removed
HealthPartners Cedar (PPO)
Renewal Plan · 2026 plan H6309-002-0
- In-network out-of-pocket maximum up from $6,000 to $9,850
- Drug deductible up from $300 to $700
- Part B giveback up from $30 to $50
- Specialist visit: $60 copay to $0-$60 copay
- Emergency care: $130 copay to $115 copay
- Urgent care: $50 copay to $40 copay
- Diagnostic radiology (MRI, CT): $350 copay to $0-$500 copay
- Outpatient hospital: $500 copay to $600 copay
- Inpatient hospital: $450 per day for days 1-5; $0 per day for days 6-90 to $600 per day for days 1-4; $0 per day for days 5-90
- Skilled nursing facility: $0 per day for days 1-20; $218 per day for days 21-100 to $0 per day for days 1-20; $221 per day for days 21-100
- Comprehensive dental removed
- Hearing aids removed
More 2027 plans in Door County
- Humana USAA Honor Giveback (PPO), H5216-355 (page for Cook County, IL)
- Humana Full Access (PPO), H7617-020 (page for Milwaukee County, WI)
- Humana USAA Honor Giveback (PPO), H7617-022 (page for Cook County, IL)
- Humana Full Access (PPO), H5216-410 (page for Milwaukee County, WI)
- Humana USAA Honor Giveback (Regional PPO), R5361-001 (page for Cook County, IL)
- HumanaChoice H5216-001 (PPO) (page for Milwaukee County, WI)
- HumanaChoice R5361-002 (Regional PPO) (page for Cook County, IL)
- Anthem Medicare Advantage 3 (PPO), H4036-008 (page for Milwaukee County, WI)
County guide: 2027 plans in Door CountyState guide: Wisconsin
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Sources and method
Plan data comes from the CMS 2027 Plan Benefit Package and landscape files. The data is from 2026-10-10. We checked a sample of plans field by field against Medicare.gov. Original Medicare amounts are the 2027 projections in the 2026 Medicare Trustees Report (Tables V.E1 and V.E2). CMS sets the final amounts in November. Wisconsin sets its own Medigap plans: a basic plan with optional riders, two cost-sharing plans, and a high-deductible plan. These plans are not the plans with letters, such as Plan G and Plan N. We have no prices or cost model for these plans, so the totals show Original Medicare without Medigap. You can look up Medigap plans and prices for ZIP 54235 on Medicare.gov. Totals use typical Medicare-allowed amounts for each service and typical drug prices.
- Network Health Select (PPO) on Medicare.gov · plan website · drug list · doctor directory
- Network Health Choice (PPO) on Medicare.gov · plan website · drug list · doctor directory
- HealthPartners Birch (PPO) on Medicare.gov · plan website · drug list · doctor directory
- HealthPartners Cedar (PPO) on Medicare.gov · plan website · drug list · doctor directory
- Medigap prices for ZIP 54235 on Medicare.gov
- Medigap plans in Wisconsin: Medicare.gov, Choosing a Medigap Policy (2026), Section 7
- CMS Plan Benefit Package files, 2027
- CMS 2027 landscape files (premiums and limits)
- CMS 2027 plan crosswalk
- CMS 2027 Star Ratings
- 2026 Medicare Trustees Report: projected 2027 Part A and Part B amounts (Tables V.E1 and V.E2)
- CMS 2026 Part A and Part B amounts
- Medicare.gov: Medigap guaranteed issue rights
These are estimates, not quotes, and they are for education only. Check every number with Medicare and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Plans can change their benefits, premiums, drug lists, and networks each year.
Pinnie is not an insurance agent or broker and does not sell Medicare plans. Pinnie is not connected with or endorsed by the U.S. government or the federal Medicare program. For all your options, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.