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Dean Advantage Assurance (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Dean Advantage Assurance (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Dean Advantage Assurance (HMO-POS) in 2026, please refer to our full plan details page.
Dean Advantage Assurance (HMO-POS) is a HMO-POS plan offered by Medica Holding Company available for enrollment in 2025 to people living in South Central Wisconsin. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Dean Advantage Assurance (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Dean Advantage Assurance (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Dean Advantage Assurance (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $50.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $380.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Dean Advantage Assurance (HMO-POS) plan features an annual drug deductible of $380. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or standard mail order. Tier 2 generic drugs are also highly affordable, with a low $11 copay for a one-month supply at preferred pharmacies and standard mail order. For brand-name and specialty medications, costs transition to coinsurance, starting at 20% for Tier 3 preferred brands and 45% for Tier 4 non-preferred drugs at preferred pharmacies. Specialty tier drugs carry a 28% coinsurance for a one-month supply, while Tier 6 vaccines are covered with no copay at both preferred and standard pharmacies. Choosing standard pharmacies instead of preferred options may result in slightly higher copays or coinsurance depending on the drug tier.
Additional Benefits
The Dean Advantage Assurance (HMO-POS) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For hospital stays, members pay a daily copay of $400 for the first five days of acute inpatient care and up to a $450 copay for outpatient services, both with no coinsurance required. Emergency room visits carry a $130 copay, while urgent care costs range from no copay to $50, with no coinsurance. Routine dental, vision, and hearing benefits are also included, featuring no copay for preventive dental cleanings up to a $600 annual limit and no copay for prescription hearing aids up to a $750 limit. Skilled nursing facility care requires no copay for the first 20 days, while durable medical equipment is covered with no copay and a coinsurance ranging from 0% to 20%. Additionally, the plan provides a $25 quarterly reimbursement for over-the-counter items and up to 24 one-way transit trips per year with no copay.
Inpatient Hospital See details
Dean Advantage Assurance (HMO-POS) covers inpatient hospital services with no coinsurance and prior authorization required, charging a $400 daily copay for days 1 through 5 of acute stays and a $350 daily copay for days 1 through 5 of psychiatric stays, with no copay for remaining covered days. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Dean Advantage Assurance (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $400 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a copay of $30 for individual sessions or $20 for group sessions with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Dean Advantage Assurance (HMO-POS) with a $105.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Dean Advantage Assurance (HMO-POS) covers ambulance services with no coinsurance and a copay of $300 for ground or $475 for air transport. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations via bus or subway, but transportation to any health-related location is not covered.
Emergency Services See details
Dean Advantage Assurance (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a copay ranging from no copay to $50 and no coinsurance. Worldwide emergency and urgent care are covered with a $125 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Dean Advantage Assurance (HMO-POS) provides primary care physician services with no copay and no coinsurance. Other covered primary care benefits, including specialist visits, physical and occupational therapy, chiropractic care, and mental health services, feature copays ranging from $0 to $50 and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by Dean Advantage Assurance (HMO-POS) with no copay and no coinsurance for covered services such as annual physical exams, kidney disease education, and glaucoma screenings. However, several additional services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, enhanced disease management, telemonitoring, home/bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Dean Advantage Assurance (HMO-POS), offering routine exams and fittings with a $40 copay, no coinsurance, and no deductible. Prescription hearing aids are covered with no copay and no coinsurance up to a $750 annual limit, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Dean Advantage Assurance (HMO-POS) covers vision services, offering routine and diagnostic eye exams with no coinsurance and copays ranging from $0 to $40. Eyewear, including contacts and eyeglasses, is covered with no copay or coinsurance up to a $175 annual maximum, with no deductibles required.
Dental Services See details
Dean Advantage Assurance (HMO-POS) partially covers dental services, offering Medicare-covered dental care for a $40 copay and no coinsurance, and preventive services like exams and cleanings with no copay or coinsurance up to a $600 yearly limit. Comprehensive services require no copay and a 50% coinsurance, but other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Dean Advantage Assurance (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this plan, Medicare Part B insulin drugs require a $30.00 to $35.00 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Dean Advantage Assurance (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Dean Advantage Assurance (HMO-POS) with no copays, though prior authorization is required for durable medical equipment and prosthetics. Covered durable medical equipment and diabetic supplies carry a coinsurance ranging from no coinsurance to 20%, while prosthetic devices, medical supplies, and diabetic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Dean Advantage Assurance (HMO-POS) partially covers diagnostic services, offering diagnostic procedures and tests with a $20 copay and no coinsurance, while lab services are not covered. Radiological services are fully covered with no coinsurance and require prior authorization, featuring no copay for diagnostic radiological services, a $45 copay for therapeutic radiological services, and a $40 copay for outpatient X-rays.
Home Health Services See details
Home Health Services are covered by Dean Advantage Assurance (HMO-POS) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Dean Advantage Assurance (HMO-POS) covers cardiac rehabilitation services with no coinsurance. Members will pay a copay of $35 for cardiac rehabilitation, $40 for intensive cardiac rehabilitation, $30 for pulmonary rehabilitation, and $25 for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Dean Advantage Assurance (HMO-POS) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and days 45 through 100, a daily copay of $218 for days 21 through 44, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Dean Advantage Assurance (HMO-POS) covers other services including acupuncture for a $40 copay and no coinsurance, alongside home infusion services and chronic illness meal benefits for no copay and no coinsurance. Over-the-counter items are covered via a $25 quarterly reimbursement with no copay and no coinsurance, while non-transport ambulance services require a $395 copay and no coinsurance. Dual eligible SNPs and certain other services are not covered.
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