Medicare Advantage · HMOPOS · 2027
Legacy Rx (HMO-POS)
No referral needed to see a specialist
At a glance: $300 monthly premium and $0 primary care visits.
- Monthly premium
- $300
- Part B premium separate
- Yearly limit
- $3,000
- Most you’d pay for in-network care
- Hearing
- $499–$999
- Copay per hearing aid
- Doctor visits
- $0
- Primary care · specialists $35
Check this plan for you
Add your doctors and prescriptions to see how they work with this plan.
- HearingCopay per hearing aid
- $499–$999
- OTC allowance
- $55/quarter
- VisionEyewear allowance ($35 exam copay)Routine eye exam: $35 copay
- $175/yr
- DentalRoutine dental benefit
- Included
- Fitness$0 fitness benefit
- Included
This is a supplemental benefit with plan-specific limits. See plan documents for details.
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TTY: 711 · Monday to Friday, 8:00 AM to 6:00 PM CST
Costs and copays
Deductibles, yearly limit, visits, hospital stays and drug tiers
- DeductiblesMedical · $0 for drugs
- $0
- Yearly limitIn-network care, not counting drugs
- $3,000
- Yearly limit, in and out of networkCombined, not counting drugs
- $6,000
- Primary doctorPer visit
- $0
- SpecialistPer visit · no referral needed
- $35
- Hospital stayNo limit on covered hospital days
- Days 1-5: $200/day, Days 6-90: $0/day
- Inpatient mental healthHospital stay
- Days 1-5: $200/day, Days 6-90: $0/day
- Outpatient surgeryPer procedure
- $100
- Emergency roomPer visit
- $150
- Urgent carePer visit
- $35
- Tier 1 · Preferred Generic30-day supply at a retail pharmacy
- $0
- Tier 2 · Generic30-day supply at a retail pharmacy
- $8
- Tier 3 · Preferred Brand30-day supply at a retail pharmacy
- 25%
- Tier 4 · Non-Pref Brand30-day supply at a retail pharmacy
- 30%
- Tier 5 · Specialty30-day supply at a retail pharmacy
- 33%
- Tier 6 · Drugs30-day supply at a retail pharmacy
- $0
Our take
Where this plan shines, and what to know
Where this plan shines
- This plan’s out-of-pocket maximum ($3,000) is among the lowest available.
- See your primary doctor for $0.
- No separate drug deductible.
- No separate medical deductible.
- Highly rated by CMS (4 stars).
- Some out-of-network care is covered (HMO-POS).
Things to know before you enroll
- Limited coverage while traveling outside the plan’s service area.
Similar plans
Other Medicare Advantage plans offered in Wisconsin
Browse the full 2027 Medicare Advantage with drug coverage directory. This plan is offered in Wisconsin. Plan availability can vary by county.
More Medicare Advantage with drug coverage options
These plans are offered in at least one of the same states. Check your ZIP or county before choosing a plan.
- Esteem Rx (HMO)Security Health Plan of Wisconsin, Inc. · H5211-012Offered in Wisconsin
- Esteem Rx Gold (HMO-POS)Security Health Plan of Wisconsin, Inc. · H5211-015Offered in Wisconsin
- Esteem Rx Silver (HMO-POS)Security Health Plan of Wisconsin, Inc. · H5211-014Offered in Wisconsin
- AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS)UnitedHealthcare · H5253-033Offered in Wisconsin
- AARP Medicare Advantage Extras from UHC WI-19 (HMO-POS)UnitedHealthcare · H5253-199Offered in Wisconsin
- AARP Medicare Advantage from UHC WI-0002 (PPO)UnitedHealthcare · H0294-004Offered in Wisconsin
Common questions
6 answers about this plan
What does Legacy Rx (HMO-POS) (HMOPOS) cover?
Legacy Rx (HMO-POS) (HMOPOS) is a Medicare Advantage plan that the current plan record identifies as including Part D prescription drug coverage. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 6 formulary tiers. Published supplemental benefits include dental (Routine dental benefit), vision ($175/yr eyewear allowance ($35 exam copay)), hearing ($499–$999 copay per hearing aid), and over-the-counter (OTC) ($55/quarter OTC allowance). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.
Learn about Medicare AdvantageHow much does Legacy Rx (HMO-POS) (HMOPOS) cost in 2027?
The published 2027 monthly plan premium for Legacy Rx (HMO-POS) (HMOPOS) is $300. Any Medicare premiums you owe are separate from the listed plan premium. The listed medical deductible is $0. The listed Part D deductible is $0. The in-network medical out-of-pocket maximum is $3,000; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $35. These figures are plan data, not a personal yearly-cost estimate.
Understand Medicare drug-cost limitsCan I use my current doctors with Legacy Rx (HMO-POS) (HMOPOS)?
CMS lists Legacy Rx (HMO-POS) (HMOPOS) as a HMOPOS plan. The plan record says specialist referrals are not required. The record also identifies point-of-service flexibility, but exact out-of-network rules can vary. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.
Check your doctorsDoes Legacy Rx (HMO-POS) (HMOPOS) cover my prescriptions?
Legacy Rx (HMO-POS) (HMOPOS) has 6 published formulary tiers in the current plan record. Published preferred-pharmacy 30-day retail costs include Tier 1 at $0, Tier 2 at $8, Tier 3 at 25%, Tier 4 at 30%, and Tier 5 at 33%. The listed Part D deductible is $0. A tier listing does not confirm that a specific prescription is covered. Check each medication against the plan's current formulary, restrictions, pharmacy network, and costs before enrolling.
Check your prescriptionsWhat dental, vision, and hearing benefits does Legacy Rx (HMO-POS) (HMOPOS) include?
The current plan record for Legacy Rx (HMO-POS) (HMOPOS) lists dental (Routine dental benefit), vision ($175/yr eyewear allowance ($35 exam copay)), and hearing ($499–$999 copay per hearing aid). It also lists over-the-counter (OTC) ($55/quarter OTC allowance). Benefit allowances, frequency, eligibility, and participating providers can have additional limits, so review the Summary of Benefits or Evidence of Coverage for the complete rules.
When can I enroll in Legacy Rx (HMO-POS) (HMOPOS)?
Legacy Rx (HMO-POS) (HMOPOS) is a 2027 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. A qualifying circumstance may create a Special Enrollment Period outside those dates. Confirm the enrollment window and effective date that apply to you before changing coverage.
Review Medicare enrollment periodsPlan documents
Summary of Benefits and Evidence of Coverage
- Summary of Benefits (PDF)Download the plan's official Summary of Benefits document
- Evidence of Coverage (PDF)Complete plan details and rules
- Check Your DoctorsSee if your doctors accept this plan
- Documentos en españolLlame a The Pocket Protector al 1-866-764-3312 (TTY: 711) para recibir ayuda con documentos en español
Talk to a licensed agent
Talk with a licensed advisor
A licensed agent can review this plan and other plans in your area that fit your needs.
TTY: 711 · Monday to Friday, 8:00 AM to 6:00 PM CST
