A non-government entity
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 2025, 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 4 out of 5 stars in 2025.
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 $53.00. 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 $300.00 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 $4500.00 (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 $4500.00 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:
Sign up for Dean Advantage Assurance (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Dean Advantage Assurance (HMO-POS) plan has a $300 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have an $8 copay at preferred pharmacies and a 20% coinsurance for standard generic drugs at preferred pharmacies. This plan offers an enhanced alternative drug benefit. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), your Part D premium will be reduced from $53.00 to $17.90.
Additional Benefits
The Dean Advantage Assurance (HMO-POS) plan provides coverage for a wide range of services. This plan includes inpatient hospital stays with a copay, outpatient services with varying copays, and emergency services with a $125 copay. The plan also covers primary care, preventive services, hearing, vision, and dental services, each with their own specific copays and coverage limits. Additional benefits include coverage for ambulance services, home health services, and skilled nursing facility stays with copays. The plan also offers benefits for home infusion, dialysis, and medical equipment, with associated copays and coinsurance. Furthermore, the plan covers other services such as acupuncture, OTC items, and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient hospital stays for acute and psychiatric care are covered, with a $350 copay for days 1-6, and no copay for days 7-90. Additional days for inpatient hospital-acute are covered with no copay, while non-Medicare covered stays and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $450, observation services with a $450 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered with a $30 copay for individual sessions and a $20 copay for group sessions, while outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Dean Advantage Assurance (HMO-POS) plan, with a $95 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Dean Advantage Assurance (HMO-POS) plan. Ground ambulance services have a $300 copay, while air ambulance services have a 20% coinsurance; Transportation services to a plan-approved health-related location are not covered, while transportation services to any health-related location are covered, up to 24 one-way trips per year via bus/subway.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Dean Advantage Assurance (HMO-POS) plan. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a copay between $0 and $50 with no coinsurance, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Dean Advantage Assurance (HMO-POS) plan covers primary care services, including chiropractic services with a $20 copay. Occupational therapy services have a $40 copay, while physician specialist services have a $0-$30 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $20-$30 copay depending on the type of session. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a $0-$30 copay.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services, an annual physical exam, and additional services not usually covered by Medicare plans. The plan also covers In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services are covered by the Dean Advantage Assurance (HMO-POS) plan, including routine hearing exams with a $30 copay and fitting/evaluation for hearing aids, with one visit allowed per year. Prescription hearing aids are covered up to a maximum of $750 every year, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with no copay, and coverage for eyewear with a combined maximum benefit of $250 every two years. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Dean Advantage Assurance (HMO-POS) plan covers dental services, including oral exams with a $55 copay, and a $500 annual maximum for other dental services. Other services are covered with a 50% coinsurance, including restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a copay of $30-$35. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Dean Advantage Assurance (HMO-POS) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment is covered under the Dean Advantage Assurance (HMO-POS) plan. Durable Medical Equipment (DME) has a coinsurance of 0% to 20%, and Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Equipment is covered, with Diabetic Therapeutic Shoes/Inserts having a coinsurance of 20%, and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for Diagnostic Procedures/Tests with a $20 copay, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $200, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $30 copay. All Radiological Services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Dean Advantage Assurance (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Dean Advantage Assurance (HMO-POS) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Dean Advantage Assurance (HMO-POS) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture with a $40 copay, Over-the-Counter (OTC) Items with a $25 maximum benefit every three months, and a meal benefit for chronic illnesses. Additionally, the plan covers ambulance service for non-transport with a $300 copay and additional home infusion services, but does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved